From the Guidelines
Overactive bladder (OAB) treatment should begin with behavioral modifications, including bladder training, scheduled voiding, pelvic floor exercises, and lifestyle changes, as these offer excellent safety and few adverse effects, as recommended by the AUA/SUFU guideline 1.
Treatment Options
The treatment options for OAB can be categorized into several groups, including:
- Behavioral therapies: bladder training, scheduled voiding, pelvic floor exercises, and lifestyle changes such as limiting caffeine, alcohol, and fluid intake before bedtime
- Pharmacologic therapies: anticholinergic medications like oxybutynin, solifenacin, or tolterodine, and beta-3 adrenergic agonists like mirabegron
- Minimally invasive therapies: Botox injections into the bladder muscle, percutaneous tibial nerve stimulation, and sacral neuromodulation
- Invasive therapies: urinary diversion, bladder augmentation cystoplasty
Recommended Approach
The AUA/SUFU guideline recommends offering behavioral therapies to all patients with OAB, as they offer excellent safety and few adverse effects 1. For patients who do not respond to behavioral therapies, pharmacologic therapies can be considered. Anticholinergic medications and beta-3 adrenergic agonists are commonly prescribed, but the choice of medication should be based on the patient's age, comorbidities, and medication interactions.
Advanced Options
For patients who do not respond to medications, more advanced options such as Botox injections, percutaneous tibial nerve stimulation, or sacral neuromodulation can be considered. These treatments have been shown to be effective in reducing voiding frequency, nocturia, and incontinence episodes in patients who have not responded to other therapies 1.
Patient-Centered Approach
Treatment selection should be based on a patient-centered approach, taking into account the patient's preferences, values, and goals. The AUA/SUFU guideline recommends integrating patient preferences and values into the treatment plan to enhance the effectiveness of OAB management 1.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The treatment options for Overactive Bladder (OAB) include:
- Mirabegron monotherapy: Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 2. The recommended starting dosage of mirabegron extended-release tablets is 25 mg orally once daily, which can be increased to a maximum dosage of 50 mg orally once daily after 4 to 8 weeks if needed 2.
From the Research
Treatment Options for Overactive Bladder (OAB)
The treatment options for Overactive Bladder (OAB) can be categorized into several approaches, including:
- Lifestyle interventions
- Pelvic floor exercises
- Bladder training
- Antimuscarinic agents
- Behavioral therapies
- Pharmacological treatments
- Minimally invasive procedures
- Surgical interventions
First-Line Treatment
First-line treatment for OAB typically involves conservative measures, such as:
- Weight reduction 3
- Decrease in exposure to bladder stimulants 3
- Fluid optimisation 3
- Pelvic floor exercises 4, 5, 6
- Bladder training 4, 5, 6
- Lifestyle modifications, including reduction of fluid intake, consumption of caffeine, sodas, weight loss, avoidance of acidic fruit juices and of spicy and acidic salty diet, alkalization of urine by diet and possibly, vitamin D supplementation 5
Pharmacological Treatments
Pharmacological treatments for OAB include:
- Anticholinergic medications, such as oxybutynin 3
- Beta-3-agonists 5
- Oral drugs, which may be combined in case of failure of monotherapy 5
Advanced Treatment Options
Advanced treatment options for OAB may include: