Alexander Hutchinson1, Alexander Nesbitt2, Andre Joshi3, Adrian Clubb4, Marlon Perera5. 1. MBBS, MSc, BA, Resident Medical Officer, Department of Urology, Mater Hospital, Qld. 2. MD, MSc, BSc, Urology Registrar, Department of Urology, Mater Hospital, Qld. 3. MBBS, MAppSc (Urol), Urology Registrar, Department of Urology, Mater Hospital, Qld. 4. MBBS, FRACS (Urol), Urology Consultant, Department of Urology, Mater Hospital, Qld. 5. MBBS, Urology Registrar, Department of Urology, Mater Hospital, Qld; Urology Registrar, Department of Surgery, Austin Health, Vic; Urology Registrar, The University of Melbourne, Vic; Urology Registrar, Faculty of Medicine, University of Queensland, Qld.
Abstract
BACKGROUND: Overactive bladder (OAB) is a common syndrome in the community characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia in the absence of detectable disease. Large studies suggest that >10% of the general population is symptomatic. OBJECTIVE: The aim of this article is to summarise the stepwise treatment for OAB that seeks to improve patient quality of life and reduce patient and health system costs. DISCUSSION: OAB is a diagnosis of exclusion that begins with a targeted history and examination of the urogenital system with the aim of assessing the burden of disease on the patient. First-line treatment comprises conservative measures including weight reduction, a decrease in exposure to bladder stimulants, fluid optimisation and pelvic floor exercises. Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin. If the patient is unresponsive to pharmacological treatment, a review by a urology specialist is appropriate. Recommendations may include minimally invasive procedures such as intravesical botulinum toxin A injections, reserving the invasive procedures for patients in specific circumstances.
BACKGROUND: Overactive bladder (OAB) is a common syndrome in the community characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia in the absence of detectable disease. Large studies suggest that >10% of the general population is symptomatic. OBJECTIVE: The aim of this article is to summarise the stepwise treatment for OAB that seeks to improve patient quality of life and reduce patient and health system costs. DISCUSSION: OAB is a diagnosis of exclusion that begins with a targeted history and examination of the urogenital system with the aim of assessing the burden of disease on the patient. First-line treatment comprises conservative measures including weight reduction, a decrease in exposure to bladder stimulants, fluid optimisation and pelvic floor exercises. Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin. If the patient is unresponsive to pharmacological treatment, a review by a urology specialist is appropriate. Recommendations may include minimally invasive procedures such as intravesical botulinum toxin A injections, reserving the invasive procedures for patients in specific circumstances.