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Overactive bladder

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Updated 2024 AUA/SUFU guidelines for the diagnosis and management of overactive bladder.

Guidelines

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 American Urological Association (AUA/SUFU 2024), the Canadian Urological Association (CUA 2024), the European Association of Urology (EAU/EAUN 2024), the American Physical Therapy Association (APTA 2023), and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2020,2014).
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Diagnostic investigations

History and physical examination: as per AUA/SUFU 2024 guidelines, elicit a medical history with a comprehensive assessment of bladder symptoms and perform a physical examination in the initial office evaluation of patients presenting with symptoms suggestive of overactive bladder.
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  • Urine tests

  • Urodynamic studies

  • Post-void residual volume

  • Urinary tract imaging

Diagnostic procedures

Cystoscopy: as per AUA/SUFU 2024 guidelines, do not perform routine cystoscopy in the initial evaluation of patients with overactive bladder. Consider performing cystoscopy in case of diagnostic uncertainty.
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Medical management

General principles: as per AUA/SUFU 2024 guidelines, engage in shared decision-making with patients with overactive bladder, taking into account their expressed values, preferences, and treatment goals, to facilitate informed decisions regarding different treatment modalities or to explore the option of no treatment.
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  • Anticholinergics and beta-3 agonists (indications)

  • Anticholinergics and beta-3 agonists (management of medication adverse effects)

  • Antibiotic prophylaxis

  • Management of genitourinary syndrome of menopause

  • Management of constipation

  • Management of fall risk

Nonpharmacologic interventions

Lifestyle modifications: as per EAU/EAUN 2024 guidelines, advise reducing caffeine intake to improve symptoms of urgency and frequency but not incontinence in adult patients with overactive bladder.
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  • Behavioral therapy

  • Bladder training

  • Pelvic floor muscle training

  • Incontinence pads and devices

  • Dietary supplements

Therapeutic procedures

General principles: as per AUA/SUFU 2024 guidelines, consider offering minimally invasive procedures in patients with overactive bladder unable or unwilling to undergo behavioral, noninvasive, or pharmacologic therapies.
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  • Urinary catheterization

  • Intradetrusor onabotulinumtoxin A

  • Tibial nerve stimulation

  • Sacral nerve stimulation

  • Vaginal electrical stimulation

  • Vaginal laser therapy

Surgical interventions

Augmentation cystoplasty: as per AUA/SUFU 2024 guidelines, consider offering bladder augmentation cystoplasty in severely impacted patients with overactive bladder not responding to all other therapeutic options.
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  • Urinary diversion

  • Detrusor myectomy

Specific circumstances

Patients with BPH
As per AUA/SUFU 2024 guidelines:
Consider offering initial management with noninvasive therapies, pharmacotherapy, or minimally invasive therapies in patients with BPH and bothersome overactive bladder, in the context of shared decision-making.
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Offer monotherapy with antimuscarinic agents or β-3 agonists, or combination therapy with an α-blocker and an antimuscarinic agent or β-3 agonist in patients with BPH and overactive bladder.
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  • Patients with postoperative overactive bladder

Patient education

General counseling: as per AUA/SUFU 2024 guidelines, engage in shared decision-making with patients with overactive bladder, taking into account their expressed values, preferences, and treatment goals, to facilitate informed decisions regarding different treatment modalities or to explore the option of no treatment.
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Follow-up and surveillance

Follow-up
As per AUA/SUFU 2024 guidelines:
Consider using telemedicine for follow-up visits with patients with overactive bladder.
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Consider obtaining urodynamic studies in patients with overactive bladder not adequately responding to pharmacotherapy or minimally invasive therapies or procedures to further evaluate bladder function and exclude other disorders.
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