Apostolos Apostolidis1, Marcio Augusto Averbeck2, Arun Sahai3, Mohhamad Sajjad Rahnama'i4, Ralf Anding5, Dudley Robinson6, Stavros Gravas7, Roger Dmochowski8. 1. 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil. 3. Department of Urology, Guy's and St.Thomas' Hospitals, London, UK. 4. Department of Urology, Maastricht University, Maastricht, The Netherlands. 5. Department of Neurourology, University Hospital Bonn, Bonn, Germany. 6. Department of Urogynaecology, King's College Hospital, NHS Foundation Trust, London, UK. 7. Department of Urology, University of Thessaly, Larissa, Greece. 8. Department of Urology, Vanderbilt University, Nashville, Tennesse.
Abstract
AIMS: To review and assess the definitions of drug resistance and the evidence supporting treatment for drug resistant overactive bladder/detrusor overactivity (OAB/DO). METHODS: Evidence review of the extant literature and consensus of opinion was used to derive the summary recommendations. RESULTS: Drug resistance or drug refractory status has been inconsistently defined and reported in current evident sources. Recent publications use some correlation of lack of efficacy and or experienced side effects to define drug resistance. Algorithms based upon these definitions largely relate to the appropriate use of neuromodulation or botulinum neurotoxin, based upon patient selection and patient choice. Current treatment pathways are hampered by inability to consistently profile patients to optimize management, particularly after failure of initial pragmatic treatment. CONCLUSIONS: Further research is recommended to better identify patient phenotype for purposes of directing optimized therapy for OAB/DO. Current treatment algorithms are influenced by extensive data generated from recent neuromodulation and botulinum neurotoxin trials.
AIMS: To review and assess the definitions of drug resistance and the evidence supporting treatment for drug resistant overactive bladder/detrusor overactivity (OAB/DO). METHODS: Evidence review of the extant literature and consensus of opinion was used to derive the summary recommendations. RESULTS: Drug resistance or drug refractory status has been inconsistently defined and reported in current evident sources. Recent publications use some correlation of lack of efficacy and or experienced side effects to define drug resistance. Algorithms based upon these definitions largely relate to the appropriate use of neuromodulation or botulinum neurotoxin, based upon patient selection and patient choice. Current treatment pathways are hampered by inability to consistently profile patients to optimize management, particularly after failure of initial pragmatic treatment. CONCLUSIONS: Further research is recommended to better identify patient phenotype for purposes of directing optimized therapy for OAB/DO. Current treatment algorithms are influenced by extensive data generated from recent neuromodulation and botulinum neurotoxin trials.
Authors: M A Elbaset; Diaa-Eldin Taha; Ahmed S El-Hefnawy; Mohamad H Zahran; A A Shokeir Journal: Int Neurourol J Date: 2019-09-30 Impact factor: 2.835