Tom Marcelissen1, Jean-Nicolas Cornu2, Tiago Antunes-Lopes3, Bogdan Geavlete4, Nicolas Barry Delongchamps5, Tina Rashid6, Malte Rieken7, Mohammad Sajjad Rahnama'i8. 1. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University Medical Centre, Maastricht, The Netherlands. 2. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Service d'urologie, CHU de Rouen, Rouen, France. 3. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Faculty of Medicine of Porto University, Centro Hospitalar São João, Porto, Portugal; Department of Urology, Centro Hospitalar São João, Porto, Portugal. 4. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania. 5. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Université Paris Descartes, Hôpital Cochin, Service d'Urologie, Paris, France. 6. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. 7. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Medical University of Vienna, Vienna, Austria. 8. European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany. Electronic address: Sajjad_r@yahoo.com.
Abstract
CONTEXT: A considerable number of patients affected by the overactive bladder syndrome (OAB) do not respond to pharmacotherapy and bladder training due to unsatisfactory response or intolerability. OBJECTIVE: To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. EVIDENCE ACQUISITION: PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. EVIDENCE SYNTHESIS: Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. CONCLUSIONS: None of the mentioned therapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. PATIENT SUMMARY: In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns.
CONTEXT: A considerable number of patients affected by the overactive bladder syndrome (OAB) do not respond to pharmacotherapy and bladder training due to unsatisfactory response or intolerability. OBJECTIVE: To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. EVIDENCE ACQUISITION: PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. EVIDENCE SYNTHESIS: Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. CONCLUSIONS: None of the mentioned therapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. PATIENT SUMMARY: In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns.
Authors: Le Mai Tu; Stefan De Wachter; Magali Robert; Roger R Dmochowski; Larry E Miller; Karel Everaert Journal: Neurourol Urodyn Date: 2018-11-29 Impact factor: 2.696