Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?
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Purpose of Review
Overactive bladder (OAB) is highly prevalent with increasing age. Conservative management including lifestyle adaptation, controlled fluid intake, and bladder training are considered first-line therapeutic options. Second-line options are medication such as antimuscarinics or beta-3 adrenergic receptor agonists. Therapy refractory patients should be referred to a specialist for further evaluation.
It currently remains unclear if patients should undergo routine urodynamic investigation (UDI) before offering third-line therapies like sacral neuromodulation (SNM) or intradetrusor injection of onabotulinumtoxinA (IdetInBotA). The aim of this narrative review was to assess if the presence of detrusor overactivity (DO) can predict treatment success of third-line therapies for OAB.
There is only limited evidence available for both IdetInBotA and SNM, but treatment success does not appear to be related to the presence of DO in baseline UDI. Hence, routine UDI is not mandatory in patients with OAB but remains an option when its outcome is likely to change the treatment strategy or to assess the risk of upper urinary tract deterioration.
KeywordsDetrusor overactivity Overactive bladder Neuromodulation therapy Sacral neuromodulation Intradetrusor injection of onabotulinumtoxinA
Compliance with Ethical Standards
Conflict of Interest
Marc P. Schneider, Andrea Tubaro, and Fiona C. Burkhard declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 4.•• Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2018; https://doi.org/10.1016/j.eururo.2017.12.031. The current European reference for diagnosing and managing urinary incontinence.
- 7.•• Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) guidelines on neuro-urology. Eur Urol. 2016;69(2):324–33. https://doi.org/10.1016/j.eururo.2015.07.071. The current European reference for diagnosing and managing lower urinary tract symptoms and dysfunction in patients with neurogenic disorders.CrossRefPubMedGoogle Scholar
- 13.Nitti VW, Rovner ES, Bavendam T. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is independent of the urodynamic finding of detrusor overactivity. BJU Int. 2010;105(9):1268–75. https://doi.org/10.1111/j.1464-410X.2009.09037.x.CrossRefPubMedGoogle Scholar
- 15.Rovner E, Kennelly M, Schulte-Baukloh H, Zhou J, Haag-Molkenteller C, Dasgupta P. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourol Urodyn. 2011;30(4):556–62. https://doi.org/10.1002/nau.21021.CrossRefPubMedGoogle Scholar
- 16.• Richter HE, Amundsen CL, Erickson SW, Jelovsek JE, Komesu Y, Chermansky C, et al. Characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation for refractory urgency urinary incontinence. J Urol. 2017;198(4):890–6. https://doi.org/10.1016/j.juro.2017.04.103. An interesting analysis of prognostic factors for clinical response to onabotulinumtoxinA and sacral neuromodulation for refractory UUI.CrossRefPubMedPubMedCentralGoogle Scholar