Overactive bladder (OAB) is known to affect millions of people worldwide, with a subsequent deleterious impact on the quality of life. The clinical diagnosis of OAB requires, at a minimum, a meticulous history, physical examination, and urinalysis. The American Urological Association views OAB as a symptom complex, not a life-threatening disease, and recommends conservative measures and behavioral therapies as first-line treatment, including bladder training, bladder control strategies, pelvic floor muscle training, and fluid management. Current medical management approved by the US FDA include anti-muscarinics and beta3-agonists. Anti-muscarincs should be avoided in patients with narrow-angle glaucoma, and used with extreme caution in patients with impaired gastric emptying or a history of urinary retention. Surgical interventions may be offered, if second-line therapy using medications is not successful in obtaining adequate symptom control of OAB, and the patient is motivated and healthy. In uncomplicated patients, OAB may be clinically diagnosed and treated with conservative measures; however, the armamentarium for the diagnosis and treatment continues to expand for more complicated patients.
Affiliations: Urology Institute, University Hospitals Case Medical Center and Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA