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Update on Management of Overactive Bladder

  • Urology (Michael Phelan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Overactive bladder (OAB) is an extremely common condition with rising incidence and increasing economic and quality-of-life burdens. Management is rapidly and constantly evolving, and this review aims to discuss recent developments in context to achieve a comprehensive overview of modern OAB treatment options.

Recent Findings

This review focuses on growing evidence for the efficacy of conservative measures including pelvic physical floor therapy and lifestyle modification. We also discuss recent developments in pharmacology that are reshaping the treatment landscape for patients refractory to first-line measures. Key examples are the novel β3 agonists vibegron and solabegron, as well as experimental therapies such as transient receptor potential inhibitors. We then discuss historical and novel neuromodulation modalities including implantable tibial nerve stimulators and pudendal nerve stimulation for appropriately selected patients.

Summary

OAB is a symptom complex consisting of urinary urgency, frequency, nocturia, and urgency urinary incontinence in the absence of contributing pathologic diagnosis such as urinary tract infection. OAB management is complex and involves escalating tiers of therapy progressing from lifestyle modification to pharmacotherapy and then to more invasive interventions including botulinum toxin injections, neuromodulation, and ultimately to last-resort therapies including bladder augmentation or urinary diversion. The quality-of-life and economic burden of OAB is significant and much work remains to be done to improve patient outcomes and expand treatment options. The economic burden of OAB and comparison of cost effectiveness of various management options is discussed, and strategies to reduce the economic burden of OAB are reviewed

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Recently published papers of particular interest have been highlighted as: ∙ Of importance

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  1. Department of Urology, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 3100, Columbus, OH, 43210, USA

    J. Patrick Mershon & Iryna Crescenze

  2. Department of Ambulatory Rehabilitation, The Ohio State University Wexner Medical Center, 920 N. Hamilton Road, Suite 400, Gahanna, OH, 43230, USA

    Brianna Rodriguez

  3. Department of Ambulatory Rehabilitation, The Ohio State University Wexner Medical Center, 7798 N Liberty St, Powell, OH, 43065, USA

    Stephanie McIntosh

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JPM wrote and prepared the final manuscript and created all tables. BR and SM assisted in preparation of the manuscript. IC assisted in preparation and editing of the final manuscript.

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Mershon, J.P., Rodriguez, B., McIntosh, S. et al. Update on Management of Overactive Bladder. Curr Surg Rep 11, 282–290 (2023). https://doi.org/10.1007/s40137-023-00374-9

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