Abstract
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.
Recent Findings
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.
Summary
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.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.
Drake MJ. Do we need a new definition of the overactive bladder syndrome? ICI-RS 2013. Neurourol Urodyn. 2014;33(5):622–4. https://doi.org/10.1002/nau.22609.
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36. https://doi.org/10.1007/s00345-002-0301-4.
•• 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.
Rovner ES, Goudelocke CM. Urodynamics in the evaluation of overactive bladder. Curr Urol Rep. 2010;11(5):343–7. https://doi.org/10.1007/s11934-010-0130-8.
Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(5 Suppl 2):28–37. discussion 40-2
•• 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.
Digesu GA, Khullar V, Cardozo L, Salvatore S. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn. 2003;22(2):105–8. https://doi.org/10.1002/nau.10099.
Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175(1):191–4; discussion 4-5. https://doi.org/10.1016/s0022-5347(05)00067-4.
Lowenstein L, Pham T, Abbasy S, Kenton K, Brubaker L, Mueller ER, et al. Observations relating to urinary sensation during detrusor overactivity. Neurourol Urodyn. 2009;28(6):497–500. https://doi.org/10.1002/nau.20680.
Guralnick ML, Grimsby G, Liss M, Szabo A, O'Connor RC. Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity. Int Urogynecol J. 2010;21(3):325–9. https://doi.org/10.1007/s00192-009-1030-7.
Hanna-Mitchell AT, Kashyap M, Chan WV, Andersson KE, Tannenbaum C. Pathophysiology of idiopathic overactive bladder and the success of treatment: a systematic review from ICI-RS 2013. Neurourol Urodyn. 2014;33(5):611–7. https://doi.org/10.1002/nau.22582.
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.
Malone-Lee JG, Al-Buheissi S. Does urodynamic verification of overactive bladder determine treatment success? Results from a randomized placebo-controlled study. BJU Int. 2009;103(7):931–7. https://doi.org/10.1111/j.1464-410X.2009.08361.x.
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.
• 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.
South MM, Romero AA, Jamison MG, Webster GD, Amundsen CL. Detrusor overactivity does not predict outcome of sacral neuromodulation test stimulation. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(12):1395–8. https://doi.org/10.1007/s00192-007-0351-7.
Groenendijk PM, Lycklama a Nyeholt AA, Heesakkers JP, van Kerrebroeck PE, Hassouna MM, Gajewski JB, et al. Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence. BJU Int. 2008;101(3):325–9. https://doi.org/10.1111/j.1464-410X.2007.07258.x.
Brading AF. A myogenic basis for the overactive bladder. Urology. 1997;50(6A Suppl):57–67. discussion 8-73
Vereecken RL, Das J. Urethral instability: related to stress and/or urge incontinence? J Urol. 1985;134(4):698–701.
Dokmeci F, Cetinkaya SE, Seval MM, Dai O. Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle. Eur J Obstet Gynecol Reprod Biol. 2017;212:126–31. https://doi.org/10.1016/j.ejogrb.2017.03.023.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Additional information
This article is part of the Topical Collection on Overactive Bladder and Lower Urinary Tract Symptoms
Rights and permissions
About this article
Cite this article
Schneider, M.P., Tubaro, A. & Burkhard, F.C. Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?. Curr Bladder Dysfunct Rep 13, 158–161 (2018). https://doi.org/10.1007/s11884-018-0480-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-018-0480-5