Diagnosis and Treatment of Idiopathic Overactive Bladder

Publication Date: April 23, 2024
Last Updated: November 6, 2024

Summary of Recommendations

Evaluation/Diagnosis

In the initial office evaluation of patients presenting with symptoms suggestive of OAB, clinicians should:
a. Obtain a medical history with comprehensive assessment of bladder symptoms,
b. Conduct a physical examination, and
c. Perform a urinalysis to exclude microhematuria and infection (Clinical Principle, )
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Clinicians may offer telemedicine to initially evaluate patients with symptoms suggestive of OAB with the understanding that a physical exam will not be performed and urinalysis should be obtained at a local laboratory (or recent lab results reviewed, if available). (Expert Opinion, )
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Clinicians may obtain a post-void residual in patients with symptoms suggestive of OAB to exclude incomplete emptying or urinary retention, especially in patients with concomitant voiding or emptying symptoms.

(Clinical Principle, )
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Clinicians may obtain a symptom questionnaire and/or a voiding diary in patients with symptoms suggestive of OAB to assist in the diagnosis of OAB, exclude other disorders, ascertain the degree of bother, and/or evaluate treatment response. (Clinical Principle, )
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Clinicians should not routinely perform urodynamics, cystoscopy, or urinary tract imaging in the initial evaluation of patients with OAB. (Clinical Principle, )
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Clinicians may perform advanced testing, such as urodynamics, cystoscopy, or urinary tract imaging in the initial evaluation of patients with OAB when diagnostic uncertainty exists. (Clinical Principle, )
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Clinicians should assess for comorbid conditions in patients with OAB that may contribute to urinary frequency, urgency, and/or urgency urinary incontinence and should educate patients on the role that managing these conditions can have on bladder symptoms. (Expert Opinion, )
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Clinicians may use telemedicine for follow-up visits with patients with OAB. (Expert Opinion, )
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Shared Decision-Making

Clinicians should engage in shared decision-making with patients with OAB taking into consideration the patient’s expressed values, preferences, and treatment goals in order to help them make an informed decision regarding different treatment modalities or to explore the option of no treatment. (Clinical Principle, )
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Non-Invasive Therapies

Clinicians should discuss incontinence management strategies (e.g., pads, diapering, barrier creams) with all patients who have urgency urinary incontinence. (Expert Opinion, )
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Clinicians should offer bladder training to all patients with OAB. (Strong, A)
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Clinicians should offer behavioral therapies to all patients with OAB. (Clinical Principle, )
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Clinicians may offer select non-invasive therapies to all patients with OAB. (Clinical Principle, )
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In patients with OAB whose symptoms do not adequately respond to monotherapy, clinicians may combine one or more of the following: behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies. (Expert Opinion, )
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Clinicians should counsel patients that there is currently insufficient evidence to support the use of nutraceuticals, vitamins, supplements, or herbal remedies in the treatment of patients with OAB. (Expert Opinion, )
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Pharmacology

Clinicians should offer antimuscarinic medications or beta-3 agonists to OAB patients to improve urinary urgency, frequency, and/or urgency urinary incontinence. (Strong, A)
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Clinicians should offer antimuscarinic medications or beta-3 agonists to OAB patients to improve urinary urgency, frequency, and/or urgency urinary incontinence. (Strong, A)
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Clinicians should discuss the potential risk for developing dementia and cognitive impairment with patients with OAB who are taking, or who are prescribed, antimuscarinic medications. (Clinical Principle, )
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Clinicians should use antimuscarinic medications with extreme caution in patients with OAB who have narrow-angle glaucoma, impaired gastric emptying, or a history of urinary retention. (Clinical Principle, )
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Clinicians should assess patients with OAB who have initiated pharmacotherapy for efficacy and for onset of treatment side effects. (Expert Opinion, )
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In patients with OAB who experience intolerable side effects or who do not achieve adequate improvement with an OAB medication, clinicians may offer a different medication in the same class or a different class of medication to obtain greater tolerability and/or efficacy. (Clinical Principle, )
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In patients with OAB who do not achieve adequate improvement with a single OAB medication, clinicians may offer combination therapy with a medication from a different class. (Conditional, B)
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Minimally Invasive Procedures

Clinicians may offer minimally invasive procedures to patients who are unable or unwilling to undergo behavioral, non-invasive, or pharmacologic therapies. (Clinical Principle, )
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Clinicians may offer patients with OAB, in the context of shared decision making, minimally invasive therapies without requiring trials of behavioral, non-invasive, or pharmacologic management. (Expert Opinion, )
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In patients with OAB who have an inadequate response to, or have experienced intolerable side effects from, pharmacotherapy or behavioral therapy, clinicians should offer sacral neuromodulation, percutaneous tibial nerve stimulation, and/or intradetrusor botulinum toxin injection. (Moderate, A)
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Clinicians should measure post-void residual in patients with OAB prior to intradetrusor botulinum toxin therapy. (Clinical Principle, )
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Clinicians should obtain a post-void residual in patients with OAB whose symptoms have not adequately improved or worsened after intradetrusor botulinum toxin injection. (Clinical Principle, )
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Clinicians should discontinue oral medications in patients with OAB who have an appropriate response to a minimally invasive procedure but should restart pharmacotherapy if efficacy is not maintained. (Expert Opinion, )
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Clinicians may perform urodynamics in patients with OAB who do not adequately respond to pharmacotherapy or minimally invasive therapies or procedures to further evaluate bladder function and exclude other disorders. (Clinical Principle, )
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Invasive Therapies

The clinician may offer bladder augmentation cystoplasty or urinary diversion in severely impacted patients with OAB who have not responded to all other therapeutic options. (Expert Opinion, )
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Indwellling Catheters

Clinicians should only recommend chronic indwelling urethral or suprapubic catheters to patients with OAB when OAB therapies are contraindicated, ineffective, or no longer desired by the patient and always in the context of shared decision-making due to risk of harm. (Expert Opinion, )
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OAB and BPH

Clinicians may offer patients with BPH and bothersome OAB, in the context of shared decision-making, initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies. (Expert Opinion, )
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Clinicians should offer patients with BPH and OAB monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist. (Conditional, B)
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Recommendation Grading

Abbreviations

  • BPH: Benign Prostatic Hyperplasia
  • OAB: Overactive Bladder
  • UTI: Urinary Tract Infection
  • UUI: Urgency Urinary Incontinence

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Diagnosis and Treatment of Idiopathic Overactive Bladder

Authoring Organizations

American Urological Association

Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction

Publication Month/Year

April 23, 2024

Last Updated Month/Year

July 31, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process that will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management

Keywords

overactive bladder, OAB

Source Citation

Cameron AP, Chung DE, Dielubanza EJ, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder. J Urol. Published online April 23, 2024. doi:10.1097/JU.0000000000003985. https://www.auajournals.org/doi/10.1097/JU.0000000000003985

Methodology

Number of Source Documents
292
Literature Search Start Date
January 1, 2013
Literature Search End Date
November 30, 2023
Specialties Involved
Obstetrics And Gynecology, Surgery General, Urology