madman
Super Moderator
ABSTRACT
Overactive bladder (OAB) is a common and distressing condition that is known to increase with age and has a significant effect on the quality of life. Whilst OAB is a symptomatic diagnosis, many patients will require basic investigations prior to initiating the appropriate management. This article will review the initial clinical assessment and management of women complaining of OAB including conservative measures and drug therapy, and will also focus on the role of estrogen. In addition, the management of refractory OAB will also be discussed including more invasive strategies such as neuromodulation, Botulinum Toxin, and reconstructive surgery.
Conclusions
Overactive bladder is a common and distressing condition that is known to have a significant effect on HRQoL. The clinical diagnosis of OAB is often one of exclusion, although urodynamic investigations are helpful in those women with refractory or unusual symptoms. The majority of women will benefit from conservative measures in the first instance although many will eventually require drug therapy. For those with refractory symptoms, switching to an alternative class of therapy may be useful and there is now considerable evidence to support the use of combination therapy in those women with persistent symptoms. The available evidence would also appear to suggest that, whilst systemic estrogen does not have a role in treating OAB, vaginal estrogen may be helpful and may also act synergistically with antimuscarinic drugs. Those patients with refractory OAB who fail to improve with medical therapy may benefit from intravesical Botulinum Toxin or neuromodulation.
Overactive bladder (OAB) is a common and distressing condition that is known to increase with age and has a significant effect on the quality of life. Whilst OAB is a symptomatic diagnosis, many patients will require basic investigations prior to initiating the appropriate management. This article will review the initial clinical assessment and management of women complaining of OAB including conservative measures and drug therapy, and will also focus on the role of estrogen. In addition, the management of refractory OAB will also be discussed including more invasive strategies such as neuromodulation, Botulinum Toxin, and reconstructive surgery.
Conclusions
Overactive bladder is a common and distressing condition that is known to have a significant effect on HRQoL. The clinical diagnosis of OAB is often one of exclusion, although urodynamic investigations are helpful in those women with refractory or unusual symptoms. The majority of women will benefit from conservative measures in the first instance although many will eventually require drug therapy. For those with refractory symptoms, switching to an alternative class of therapy may be useful and there is now considerable evidence to support the use of combination therapy in those women with persistent symptoms. The available evidence would also appear to suggest that, whilst systemic estrogen does not have a role in treating OAB, vaginal estrogen may be helpful and may also act synergistically with antimuscarinic drugs. Those patients with refractory OAB who fail to improve with medical therapy may benefit from intravesical Botulinum Toxin or neuromodulation.
