Refractory overactive bladder

Overactive bladder (OAB) is a prevalent health issue that affects millions of people of all ages around the world. OAB comprises a constellation of symptoms that includes urinary frequency and urgency with or without urgency incontinence and can have a tremendous impact on an individual's quality of life. The American Urological Association OAB guidelines suggests starting with first- and second-line therapies that include conservative measures (avoidance of dietary bladder irritants and physical therapy) and pharmacotherapy (antimuscarinics or beta-3 agonists), respectively. When first- and second-line therapies are ineffective in providing relief of symptoms, one can consider more advanced therapies such as neuromodulation, onabotulinum toxin A injection of the bladder, and surgical reconstruction of the lower urinary tract. This chapter provides a case-based illustration of the approach to OAB.