Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?
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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