Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015)

Apostolos Apostolidis*, Marcio Augusto Averbeck, Arun Sahai, Sajjad Rahnama'i, Ralf Anding, Dudley Robinson, Stavros Gravas, Roger Dmochowski

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

26 Citations (Web of Science)

Abstract

AimsTo review and assess the definitions of drug resistance and the evidence supporting treatment for drug resistant overactive bladder/detrusor overactivity (OAB/DO).

MethodsEvidence review of the extant literature and consensus of opinion was used to derive the summary recommendations.

ResultsDrug 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.

ConclusionsFurther 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.

Original languageEnglish
Pages (from-to)882-893
Number of pages12
JournalNeurourology and Urodynamics
Volume36
Issue number4
DOIs
Publication statusPublished - Apr 2017
EventICI-RS Meeting - Bristol
Duration: 1 Jun 2015 → …

Keywords

  • anticholinegics
  • antimuscarinics
  • augmentation cystoplasty
  • botulinum (neuro)toxin
  • detrusor myectomy
  • drug resistant
  • guidelines
  • management
  • neuromodulation
  • overactive bladder
  • percutaneous tibial nerve stimulation
  • refractory
  • treatment
  • urinary diversion
  • TIBIAL NERVE-STIMULATION
  • URINARY URGE INCONTINENCE
  • PLACEBO-CONTROLLED TRIAL
  • BOTULINUM-TOXIN-A
  • QUALITY-OF-LIFE
  • RANDOMIZED CLINICAL-TRIAL
  • CORD-INJURY PATIENTS
  • SACRAL NEUROMODULATION
  • DOUBLE-BLIND
  • AUGMENTATION CYSTOPLASTY

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