Overactive Bladder - AUA guidelines
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The OAB guidelines recommend behavioral approaches as a first-line treatment, including bladder training, pelvic floor muscle training, and fluid management. Second-line treatment recommendations include medications (ie, darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium), which can also be combined with behavioral approaches as first-line treatment.
In more severe cases that are refractory to second-line treatment, or in patients who cannot tolerate antimuscarinics, clinicians should offer sacral neuromodulation or percutaneous tibial nerve stimulation for carefully selected patients.
The guidelines also recommend as third-line, the non-FDA approved approach of intradetrusor onabotulinumtoxinA in the "carefully-selected and thoroughly-counseled patient who has been refractory to first- and second-line OAB treatments."
The OAB panel, led by E. Ann Gormley, MD, from the Department of Urology at the William Beaumont Hospital, Royal Oak, Michigan, based their recommendations on a report from the Agency for Healthcare Research and Quality (AHRQ) that extracted data from 151 studies on OAB published in English between January 1966 and October 2008. The panel also evaluated relevant articles not included in the AHRQ report and published between October 2008 and December 2011. Most of the treatment recommendations had an evidence strength of B (moderate) or C (low).