Overactive bladder (OAB) is a prevalent symptom syndrome that becomes more prevalent with increasing age with an unclear aetiology. OAB is often associated with the urodynamic finding of detrusor overactivity. Symptoms include urinary urgency, frequency and nocturia and may or not be associated with urinary incontinence. The condition is known to have a significant impact on quality of life. Assessment of OAB requires a thorough assessment of patients’ medical history, examination and severity assessment before commencing treatment.
Treatment of OAB is often multimodal with lifestyle changes and pharmacotherapy. Refractory OAB can be described as failure to respond to medical management of OAB. Alternative second-line treatments with intra-vesical injections of botulinum A toxin and neuromodulation methods can be highly effective however are invasive and expensive and can require long-term follow-up with top-up treatments. In absolute refractory cases, surgery can be considered. These are discussed further.
KeywordsOveractive bladder Detrusor overactivity Urinary frequency Botulinum A toxin Tricyclic antidepressants Desmopressin β3-adrenoceptor agonist Anti-muscarinic drugs Oestrogen
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