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Overactive bladder

Key sources
The following summarized guidelines for the evaluation and management of overactive bladder are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2023), the American Physical Therapy Association (APTA 2023), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2020; 2014), and the American Urological Association (AUA/SUFU 2019).
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Guidelines

1.Diagnostic investigations

History and physical examination
As per EAU 2023 guidelines:
Ask patients to complete at least a 3-day bladder diary at initial evaluation for overactive bladder.
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Elicit a history of current medication use in all patients with overactive bladder. Review any new medication associated with the development or worsening of overactive bladder symptoms.
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  • Urine tests

  • Urodynamic studies

  • Urinary tract imaging

2.Diagnostic procedures

Cystoscopy: do not perform cystoscopy in the initial evaluation of patients with uncomplicated overactive bladder.
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3.Medical management

Anticholinergics and beta-3 agonists: as per EAU 2023 guidelines, offer anticholinergic drugs in female patients with overactive bladder failing conservative treatment.
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4.Nonpharmacologic interventions

Lifestyle modifications: as per APTA 2023 guidelines, offer behavioral interventions, including dietary and fluid modification and urge suppression techniques, to improve symptoms of urgency urinary incontinence, urinary urgency, and/or urinary frequency.
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  • Behavioral therapy

  • Bladder training

  • Pelvic floor muscle training

  • Incontinence pads and devices

5.Therapeutic procedures

Urinary catheterization: do not offer indwelling catheters as a management strategy for overactive bladder because of the adverse risk/benefit balance, except as a last resort in selected patients.
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6.Surgical interventions

Augmentation cystoplasty
As per EAU 2023 guidelines:
Offer augmentation cystoplasty in patients with overactive bladder/UUI not responding to all other treatment options and after informing about all possible complications.
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Inform patients undergoing augmentation cystoplasty of the high risk of clean intermittent self-catheterization (ensure they are willing and able to do so) and that they will need life- long surveillance.
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  • Urinary diversion

  • Detrusor myectomy

7.Patient education

General counseling: as per APTA 2023 guidelines, counsel patients about the improved outcomes when medications are combined with pelvic health rehabilitation for urgency urinary incontinence, urinary urgency, and/or urinary frequency.
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8.Follow-up and surveillance

Management of medication adverse effects
As per EAU 2023 guidelines:
Encourage early review of efficacy and adverse effects of anticholinergic medications in patients with overactive bladder.
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Obtain early follow-up in female patients initiated anticholinergic or β-3 agonist therapy.
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  • Follow-up