The evolving role of the specialist in the diagnosis and management of the patient with OAB

The management of overactive bladder (OAB) has changed considerably over recent years and is to a great extent still evolving. Modern management guidelines suggest that where the symptoms of OAB are present (i.e. urgency with or without urge incontinence, usually with frequency and nocturia), sophisticated diagnostic testing is not warranted. Urodynamic studies, rather than being a necessity, should be reserved for those patients with refractory/complicated OAB. First-line or non-specialist diagnosis of OAB is symptom-based, with subsequent treatment decisions taking into consideration factors such as age, gender and patient preference. None of the available treatment options are ideal for OAB. Medical and behavioral therapies are the cornerstone of first-line treatment, and muscarinic receptor antagonists the drugs of choice. But the clinical utility of some available agents has been limited by perceived low levels of efficacy and troublesome side effects. In refractory cases, invasive neuromodulatory and surgical techniques can improve the symptoms associated with OAB, but with varying success. Invasive in nature, they are third- and fourth-line treatment options. An optimum treatment algorithm for OAB is not yet established. A regimen that adequately improves symptoms, has minimal adverse events, and so enhances patient quality of life, is the ultimate goal.

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