Diagnostic Considerations

The term overactive bladder (OAB) refers to a symptom complex. Therefore, the first part of the evaluation of OAB is to review the patient’s lower urinary tract symptoms to ensure that the symptoms are consistent with OAB.

A diagnosis of OAB depends on the presence of urgency, which differs from a simple urge to void. A typical urge to void is a normal sensation that progressively strengthens when deferred. In contrast, urgency is an abnormal condition that is characterized by a sudden onset of a desire to void that is difficult to defer.

Nocturia is often confused with lower urinary tract symptoms (LUTS) and assumed to be a symptom of OAB or, in men, of benign prostatic hyperplasia (BPH). Not all patients with nocturia have OAB or BPH, and the relationship between nocturia and OAB is not well understood. A 2011 consensus statement on the evaluation and treatment of nocturia concluded that most patients with nocturia do not have OAB but most patients with OAB do have nocturia.^[27]

Other causes of urinary frequency, urgency, and urinary incontinence must be excluded. Urinary incontinence has several subtypes: stress, urge, mixed, overflow, and transient. Transient incontinence may be related to any of a number of conditions, easily recalled by means of the following mnemonic, DIAPPERS:

Delirium
Infection
Atrophy
Pharmaceuticals
Psychological factors
Excess urine output
Restricted mobility
Stool impaction

Other conditions to consider include the following:

Urinary stone disease
Bladder cancer (must be ruled out if the patient has microscopic or gross hematuria)
Gastrointestinal (GI) pathology
Gynecologic pathology

Differential Diagnoses

Workup

Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Res Rep Urol. 2016. 8:113-22. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019 Sep. 202 (3):558-563. [QxMD MEDLINE Link]. [Full Text].
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002. 21(2):167-78. [QxMD MEDLINE Link].
Dmochowski RR. Duloxetine: a summary of published clinical experience. Rev Urol. 2004. 6 Suppl 3:S56-63. [QxMD MEDLINE Link]. [Full Text].
Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J Urol. 2006 Mar. 175(3 Pt 2):S5-10. [QxMD MEDLINE Link].
Morrison J, Steers WD, Brading AF, et al. Neurophysiology and neuropharmacology. Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. 2nd ed. Plymouth, England: Health Publications; 2002. 86-163.
de Groat WC. The urothelium in overactive bladder: passive bystander or active participant?. Urology. 2004 Dec. 64(6 Suppl 1):7-11. [QxMD MEDLINE Link].
Andersson KE, Hedlund P. Pharmacologic perspective on the physiology of the lower urinary tract. Urology. 2002 Nov. 60(5 Suppl 1):13-20; discussion 20-1. [QxMD MEDLINE Link].
DuBeau CE. Interpreting the effect of common medical conditions on voiding dysfunction in the elderly. Urol Clin North Am. 1996 Feb. 23(1):11-8. [QxMD MEDLINE Link].
Miller SW. Management and treatment of overactive bladder in the elderly. J Am Soc Consult Pharm. 1999. 14(Suppl 4):S1-S11.
Shah D, Badlani G. Treatment of overactive bladder and incontinence in the elderly. Rev Urol. 2002. 4 Suppl 4:S38-43. [QxMD MEDLINE Link]. [Full Text].
Staskin DR. Overactive bladder in the elderly: a guide to pharmacological management. Drugs Aging. 2005. 22(12):1013-28. [QxMD MEDLINE Link].
Stoddart H, Donovan J, Whitley E, Sharp D, Harvey I. Urinary incontinence in older people in the community: a neglected problem?. Br J Gen Pract. 2001 Jul. 51(468):548-52. [QxMD MEDLINE Link]. [Full Text].
Voytas J. The role of geriatricians and family practitioners in the treatment of overactive bladder and incontinence. Rev Urol. 2002. 4 Suppl 4:S44-9. [QxMD MEDLINE Link]. [Full Text].
Cheng CL, Li JR, Lin CH, de Groat WC. Positive association of female overactive bladder symptoms and estrogen deprivation: A nationwide population-based cohort study in Taiwan. Medicine (Baltimore). 2016 Jul. 95 (28):e4107. [QxMD MEDLINE Link].
Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003 May. 20(6):327-36. [QxMD MEDLINE Link].
Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001 Jun. 87(9):760-6. [QxMD MEDLINE Link].
Abrams P, Kelleher CJ, Kerr LA, Rogers RG. Overactive bladder significantly affects quality of life. Am J Manag Care. 2000 Jul. 6(11 Suppl):S580-90. [QxMD MEDLINE Link].
Davila GW, Neimark M. The overactive bladder: prevalence and effects on quality of life. Clin Obstet Gynecol. 2002 Mar. 45(1):173-81. [QxMD MEDLINE Link].
Szabo SM, Gooch KL, Walker DR, Johnston KM, Wagg AS. The Association Between Overactive Bladder and Falls and Fractures: A Systematic Review. Adv Ther. 2018 Nov. 35 (11):1831-1841. [QxMD MEDLINE Link]. [Full Text].
Hu TW, Wagner TH, Bentkover JD, LeBlanc K, Piancentini A, Stewart WF, et al. Estimated economic costs of overactive bladder in the United States. Urology. 2003 Jun. 61(6):1123-8. [QxMD MEDLINE Link].
Liberman JN, Hunt TL, Stewart WF, Wein A, Zhou Z, Herzog AR, et al. Health-related quality of life among adults with symptoms of overactive bladder: results from a U.S. community-based survey. Urology. 2001 Jun. 57(6):1044-50. [QxMD MEDLINE Link].
Jayadevappa R, Chhatre S, Newman DK, Schwartz JS, Wein AJ. Association between overactive bladder treatment and falls among older adults. Neurourol Urodyn. 2018 May 28. [QxMD MEDLINE Link].
Bailey KL, Torigoe Y, Zhou S, et al. Overactive bladder cost of illness: Analysis of Medi-Cal claims. Presented at the International Society for Pharmacoeconomics and Outcomes Research 5th Annual International meeting,. Arlington, VA. May 21-24, 2000.
Brown JS, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud KE, et al. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000 Jul. 48(7):721-5. [QxMD MEDLINE Link].
Chapple C, Kelleher C, Siddiqui E, Andrae DA, Johnson N, Payne C, et al. Validation of the Overactive Bladder-Bladder Assessment Tool (OAB-BAT): A Potential Alternative to the Standard Bladder Diary for Monitoring OAB Outcomes. Eur Urol Focus. 2021 Sep. 7 (5):1176-1183. [QxMD MEDLINE Link].
Weiss JP, Blaivas JG, Bliwise DL, Dmochowski RR, Dubeau CE, Lowe FC, et al. The evaluation and treatment of nocturia: a consensus statement. BJU Int. 2011 Jul. 108(1):6-21. [QxMD MEDLINE Link].
Nitti VW, Patel A, Karram M. Diagnosis and management of overactive bladder: A review. J Obstet Gynaecol Res. 2021 May. 47 (5):1654-1665. [QxMD MEDLINE Link]. [Full Text].
Mostafaei H, Shariat SF, Salehi-Pourmehr H, Janisch F, Mori K, Quhal F, et al. The clinical pharmacology of the medical treatment for overactive bladder in adults. Expert Rev Clin Pharmacol. 2020 Jul. 13 (7):707-720. [QxMD MEDLINE Link].
Chen LC, Kuo HC. Current management of refractory overactive bladder. Low Urin Tract Symptoms. 2020 May. 12 (2):109-116. [QxMD MEDLINE Link].
Alhasso AA, McKinlay J, Patrick K, Stewart L. Anticholinergic drugs versus non-drug active therapies for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006 Oct 18. CD003193. [QxMD MEDLINE Link].
Chughtai B, Clemens JQ, Thomas D, Sun T, Ghomrawi H, Sedrakyan A. Real World Performance of Sacral Neuromodulation and OnabotulinumtoxinA for Overactive Bladder: Focus on Safety and Cost. J Urol. 2020 Jan. 203 (1):179-184. [QxMD MEDLINE Link].
Burgio KL. Influence of behavior modification on overactive bladder. Urology. 2002 Nov. 60(5 Suppl 1):72-6; discussion 77. [QxMD MEDLINE Link].
Wilson PD, Berghmans B, Hagen S, et al. Adult conservative management. Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence Management. Paris, France.: Health Publications; 2005. 855-94.
Wyman JF, Fantl JA, McClish DK, Bump RC. Comparative efficacy of behavioral interventions in the management of female urinary incontinence. Continence Program for Women Research Group. Am J Obstet Gynecol. 1998 Oct. 179(4):999-1007. [QxMD MEDLINE Link].
Wyman JF, Fantl JA. Bladder training in ambulatory care management of urinary incontinence. Urol Nurs. 1991 Sep. 11(3):11-7. [QxMD MEDLINE Link].
Burgio KL, Goode PS, Locher JL, Umlauf MG, Roth DL, Richter HE, et al. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA. 2002 Nov 13. 288(18):2293-9. [QxMD MEDLINE Link].
Cardozo L, Stanton SL, Hafner J, Allan V. Biofeedback in the treatment of detrusor instability. Br J Urol. 1978 Jun. 50(4):250-4. [QxMD MEDLINE Link].
Cardozo LD, Abrams PD, Stanton SL, Feneley RC. Idiopathic bladder instability treated by biofeedback. Br J Urol. 1978 Dec. 50(7):521-3. [QxMD MEDLINE Link].
Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training. Ann Intern Med. 1985 Oct. 103(4):507-15. [QxMD MEDLINE Link].
Sirls ER, Killinger KA, Boura JA, Peters KM. Percutaneous Tibial Nerve Stimulation in the Office Setting: Real World Experience of Over 100 Patients. Urology. 2017 Nov 28. [QxMD MEDLINE Link].
Stewart F, Gameiro LF, El Dib R, Gameiro MO, Kapoor A, Amaro JL. Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Cochrane Database Syst Rev. 2016 Dec 9. 12:CD010098. [QxMD MEDLINE Link].
Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013 Jun. 189 (6):2194-201. [QxMD MEDLINE Link].
Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M, et al. Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA. 1998 Dec 16. 280(23):1995-2000. [QxMD MEDLINE Link].
Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991 Feb 6. 265(5):609-13. [QxMD MEDLINE Link].
Burgio KL, Locher JL, Goode PS. Combined behavioral and drug therapy for urge incontinence in older women. J Am Geriatr Soc. 2000 Apr. 48(4):370-4. [QxMD MEDLINE Link].
Burgio KL, Kraus SR, Johnson TM 2nd, Markland AD, Vaughan CP, Li P, et al. Effectiveness of Combined Behavioral and Drug Therapy for Overactive Bladder Symptoms in Men: A Randomized Clinical Trial. JAMA Intern Med. 2020 Jan 13. [QxMD MEDLINE Link].
Burton JR, Pearce KL, Burgio KL, Engel BT, Whitehead WE. Behavioral training for urinary incontinence in elderly ambulatory patients. J Am Geriatr Soc. 1988 Aug. 36(8):693-8. [QxMD MEDLINE Link].
McDowell BJ, Burgio KL, Dombrowski M, Locher JL, Rodriguez E. An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients. J Am Geriatr Soc. 1992 Apr. 40(4):370-4. [QxMD MEDLINE Link].
Herbison P, Hay-Smith J, Ellis G, Moore K. Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. BMJ. 2003 Apr 19. 326(7394):841-4. [QxMD MEDLINE Link]. [Full Text].
Lepor H. A comparison of anticholinergic therapies in the treatment of overactive bladder. Rev Urol. 2001 Fall. 3(4):209. [QxMD MEDLINE Link]. [Full Text].
MacDiarmid SA. Overactive bladder: improving the efficacy of anticholinergics by dose escalation. Curr Urol Rep. 2003 Dec. 4(6):446-51. [QxMD MEDLINE Link].
Nabi G, Cody JD, Ellis G, Herbison P, Hay-Smith J. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006 Oct 18. CD003781. [QxMD MEDLINE Link].
Reynolds WS, McPheeters M, Blume J, Surawicz T, Worley K, Wang L, et al. Comparative Effectiveness of Anticholinergic Therapy for Overactive Bladder in Women: A Systematic Review and Meta-analysis. Obstet Gynecol. 2015 Jun. 125 (6):1423-32. [QxMD MEDLINE Link].
Lee YS, Choo MS, Lee JY, et al. Symptom change after discontinuation of successful antimuscarinic treatment in patients with overactive bladder symptoms: a randomised, multicentre trial. Int J Clin Pract. 2011 Sep. 65(9):997-1004. [QxMD MEDLINE Link].
Tapp AJ, Cardozo LD, Versi E, Cooper D. The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study. Br J Obstet Gynaecol. 1990 Jun. 97(6):521-6. [QxMD MEDLINE Link].
Roberts RG, Garely AD, Bavendam T. Safety and tolerability of tolterodine for the treatment of overactive bladder in adults. Am J Manag Care. 2005 Jul. 11(4 Suppl):S158-62. [QxMD MEDLINE Link].
Abrams P. Evidence for the efficacy and safety of tolterodine in the treatment of overactive bladder. Expert Opin Pharmacother. 2001 Oct. 2(10):1685-701. [QxMD MEDLINE Link].
Kanofsky JA, Nitti VW. Tolterodine for treatment of overactive bladder. Urol Clin North Am. 2006 Nov. 33(4):447-53, viii. [QxMD MEDLINE Link].
Diokno AC, Appell RA, Sand PK, Dmochowski RR, Gburek BM, Klimberg IW, et al. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clin Proc. 2003 Jun. 78(6):687-95. [QxMD MEDLINE Link].
Gupta SK, Sathyan G. Pharmacokinetics of an oral once-a-day controlled-release oxybutynin formulation compared with immediate-release oxybutynin. J Clin Pharmacol. 1999 Mar. 39(3):289-96. [QxMD MEDLINE Link].
Zinner NR, Mattiasson A, Stanton SL. Efficacy, safety, and tolerability of extended-release once-daily tolterodine treatment for overactive bladder in older versus younger patients. J Am Geriatr Soc. 2002 May. 50(5):799-807. [QxMD MEDLINE Link].
Burgio KL, Goode PS, Johnson TM, et al. Behavioral Versus Drug Treatment for Overactive Bladder in Men: The Male Overactive Bladder Treatment in Veterans (MOTIVE) Trial. J Am Geriatr Soc. 2011 Dec. 59(12):2209-16. [QxMD MEDLINE Link].
Staskin DR. Trospium chloride: Distinct among other anticholinergic agents available for the treatment of overactive bladder. Urol Clin North Am. 2006 Nov. 33(4):465-73, viii. [QxMD MEDLINE Link].
Zinner NR. Trospium chloride: an anticholinergic quaternary ammonium compound for the treatment of overactive bladder. Expert Opin Pharmacother. 2005 Jul. 6(8):1409-20. [QxMD MEDLINE Link].
Brunton S, Kuritzky L. Recent developments in the management of overactive bladder: focus on the efficacy and tolerability of once daily solifenacin succinate 5 mg. Curr Med Res Opin. 2005 Jan. 21(1):71-80. [QxMD MEDLINE Link].
Kelleher CJ, Cardozo L, Chapple CR, Haab F, Ridder AM. Improved quality of life in patients with overactive bladder symptoms treated with solifenacin. BJU Int. 2005 Jan. 95(1):81-5. [QxMD MEDLINE Link].
Maniscalco M, Singh-Franco D, Wolowich WR, Torres-Colón R. Solifenacin succinate for the treatment of symptoms of overactive bladder. Clin Ther. 2006 Sep. 28(9):1247-72. [QxMD MEDLINE Link].
Wagg A, Wyndaele JJ, Sieber P. Efficacy and tolerability of solifenacin in elderly subjects with overactive bladder syndrome: a pooled analysis. Am J Geriatr Pharmacother. 2006 Mar. 4(1):14-24. [QxMD MEDLINE Link].
Zinner N, Susset J, Gittelman M, Arguinzoniz M, Rekeda L, Haab F. Efficacy, tolerability and safety of darifenacin, an M(3) selective receptor antagonist: an investigation of warning time in patients with OAB. Int J Clin Pract. 2006 Jan. 60(1):119-26. [QxMD MEDLINE Link].
Doheny K. FDA OKs First OTC Remedy for Overactive Bladder. Medscape Medical News. Available at http://www.medscape.com/viewarticle/778226. January 25, 2013; Accessed: December 17, 2022.
Herschorn S, Swift S, Guan Z, et al. Comparison of fesoterodine and tolterodine extended release for the treatment of overactive bladder: a head-to-head placebo-controlled trial. BJU Int. 2010 Jan. 105(1):58-66. [QxMD MEDLINE Link].
Cardozo L, Amarenco G, Pushkar D, Mikulas J, Drogendijk T, Wright M, et al. Severity of overactive bladder symptoms and response to dose escalation in a randomized, double-blind trial of solifenacin (SUNRISE). BJU Int. 2013 May. 111(5):804-10. [QxMD MEDLINE Link].
Vouri SM, Kebodeaux CD, Stranges PM, Teshome BF. Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2017 Mar - Apr. 69:77-96. [QxMD MEDLINE Link].
Chapple CR, Yamanishi T, Chess-Williams R. Muscarinic receptor subtypes and management of the overactive bladder. Urology. 2002 Nov. 60(5 Suppl 1):82-8; discussion 88-9. [QxMD MEDLINE Link].
Michel MC, Hegde SS. Treatment of the overactive bladder syndrome with muscarinic receptor antagonists: a matter of metabolites?. Naunyn Schmiedebergs Arch Pharmacol. 2006 Nov. 374(2):79-85. [QxMD MEDLINE Link].
Izett M, Zacche M, Thiagamoorthy G, Robinson D, Cardozo L. Current evidence and emerging drug therapies for overactive bladder. Minerva Ginecol. 2017 Jun. 69 (3):269-285. [QxMD MEDLINE Link].
Myrbetriq (mirabegron) [package insert]. Northbrook, Il: Astellas Pharma. June 2012. Available at [Full Text].
Chapple CR, Kaplan SA, Mitcheson D, et al. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a ß(3)-adrenoceptor agonist, in overactive bladder. Eur Urol. 2013 Feb. 63(2):296-305. [QxMD MEDLINE Link].
Khullar V, Amarenco G, Angulo JC, et al. Efficacy and tolerability of mirabegron, a β3-adrenoceptor agonist, in patients with overactive bladder: Results from a randomised European-Australian phase 3 trial. Eur Urol. November 2012.
De Nunzio C, Brucker B, Bschleipfer T, Cornu JN, Drake MJ, Fusco F, et al. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men. Eur Urol. 2021 Jan 2. [QxMD MEDLINE Link].
Mullen GR, Kaplan SA. Efficacy and Safety of Mirabegron in Men with Overactive Bladder Symptoms and Benign Prostatic Hyperplasia. Curr Urol Rep. 2021 Jan 7. 22 (1):5. [QxMD MEDLINE Link].
Chapple CR, Siddiqui E. Mirabegron for the treatment of overactive bladder: a review of efficacy, safety and tolerability with a focus on male, elderly and antimuscarinic poor-responder populations, and patients with OAB in Asia. Expert Rev Clin Pharmacol. 2017 Feb. 10 (2):131-151. [QxMD MEDLINE Link].
Staskin D, Frankel J, Varano S, Shortino D, Jankowich R, Mudd PN Jr. International Phase III, Randomized, Double-Blind, Placebo and Active Controlled Study to Evaluate the Safety and Efficacy of Vibegron in Patients with Symptoms of Overactive Bladder: EMPOWUR. J Urol. 2020 Aug. 204 (2):316-324. [QxMD MEDLINE Link].
Staskin D, Frankel J, Varano S, Shortino D, Jankowich R, Mudd PN Jr. Once-Daily Vibegron 75 mg for Overactive Bladder: Long-Term Safety and Efficacy From a Double-Blind Extension Study of the International Phase 3 Trial (EMPOWUR). J Urol. 2020 Dec 28. 101097JU0000000000001574. [QxMD MEDLINE Link].
Rechberger T, Wróbel A. Evaluating vibegron for the treatment of overactive bladder. Expert Opin Pharmacother. 2021 Jan. 22 (1):9-17. [QxMD MEDLINE Link].
Abrams P, Kelleher C, Staskin D, Kay R, Martan A, Mincik I, et al. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: exploratory responder analyses of efficacy and evaluation of patient-reported outcomes from a randomized, double-blind, factorial, dose-ranging, Phase II study (SYMPHONY). World J Urol. 2016 Aug 11. [QxMD MEDLINE Link].
Drake MJ, Chapple C, Esen AA, Athanasiou S, Cambronero J, Mitcheson D, et al. Efficacy and Safety of Mirabegron Add-on Therapy to Solifenacin in Incontinent Overactive Bladder Patients with an Inadequate Response to Initial 4-Week Solifenacin Monotherapy: A Randomised Double-blind Multicentre Phase 3B Study (BESIDE). Eur Urol. 2016 Jul. 70 (1):136-45. [QxMD MEDLINE Link].
Wada N, Iuchi H, Kita M, Hashizume K, Matsumoto S, Kakizaki H. Urodynamic Efficacy and Safety of Mirabegron Add-on Treatment with Tamsulosin for Japanese Male Patients with Overactive Bladder. Low Urin Tract Symptoms. 2016 Sep. 8 (3):171-6. [QxMD MEDLINE Link].
Abrams P, Kelleher C, Staskin D, Kay R, Martan A, Mincik I, et al. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: exploratory responder analyses of efficacy and evaluation of patient-reported outcomes from a randomized, double-blind, factorial, dose-ranging, Phase II study (SYMPHONY). World J Urol. 2016 Aug 11. [QxMD MEDLINE Link].
FDA Approves Botox To Treat Overactive Bladder. U.S. Food & Drug Administration. Available at https://wayback.archive-it.org/7993/20161022204431/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336101.htm. Jan 18 2013; Accessed: December 17, 2022.
Khan S, Game X, Kalsi V, Gonzales G, Panicker J, Elneil S, et al. Long-term effect on quality of life of repeat detrusor injections of botulinum neurotoxin-a for detrusor overactivity in patients with multiple sclerosis. J Urol. 2011 Apr. 185(4):1344-9. [QxMD MEDLINE Link].
Visco AG, Brubaker L, Richter HE, Nygaard I, Paraiso MF, Menefee SA, et al. Anticholinergic therapy vs. onabotulinumtoxina for urgency urinary incontinence. N Engl J Med. 2012 Nov 8. 367(19):1803-13. [QxMD MEDLINE Link]. [Full Text].
Drake MJ, Nitti VW, Ginsberg DA, Brucker BM, Hepp Z, McCool R, et al. Comparative assessment of the efficacy of onabotulinumtoxinA and oral therapies (anticholinergics and mirabegron) for overactive bladder: a systematic review and network meta-analysis. BJU Int. 2017 Nov. 120 (5):611-622. [QxMD MEDLINE Link].
Marcelissen TA, Rahnama'i MS, Snijkers A, Schurch B, De Vries P. Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms. World J Urol. 2016 Jun 7. [QxMD MEDLINE Link].
Noblett K, Benson K, Kreder K. Detailed analysis of adverse events and surgical interventions in a large prospective trial of sacral neuromodulation therapy for overactive bladder patients. Neurourol Urodyn. 2016 Aug 4. [QxMD MEDLINE Link].
Axonics Sacral Neuromodulation (SNM) System for Urinary Control – P180046. U.S. Food & Drug Administration. Available at https://fda.report/PMA/P180046/18/P180046B.pdf. December 13, 2019; Accessed: December 17, 2022.
[Guideline] Poole RL, Dale M, Morgan H, Oladapo T, Brookfield R, Morris R. Axonics Sacral Neuromodulation System for Treating Refractory Overactive Bladder: A NICE Medical Technologies Guidance. Appl Health Econ Health Policy. 2022 May. 20 (3):305-313. [QxMD MEDLINE Link]. [Full Text].
Zhang J, Cheng W, Cai M. Effects of electroacupuncture on overactive bladder refractory to anticholinergics: a single-blind randomised controlled trial. Acupunct Med. 2015 Jun 3. [QxMD MEDLINE Link].
Thiagamoorthy G, Cardozo L, Robinson D. Current and future pharmacotherapy for treating overactive bladder. Expert Opin Pharmacother. 2016 Jul. 17 (10):1317-25. [QxMD MEDLINE Link].
Majima T, Funahashi Y, Takai S, Goins WF, Gotoh M, Tyagi P, et al. Herpes Simplex Virus Vector-Mediated Gene Delivery of Poreless TRPV1 Channels Reduces Bladder Overactivity and Nociception in Rats. Hum Gene Ther. 2015 Nov. 26 (11):734-42. [QxMD MEDLINE Link]. [Full Text].
Robinson D, Hanna-Mitchell A, Rantell A, Thiagamoorthy G, Cardozo L. Are we justified in suggesting change to caffeine, alcohol, and carbonated drink intake in lower urinary tract disease? Report from the ICI-RS 2015. Neurourol Urodyn. 2017 Apr. 36 (4):876-881. [QxMD MEDLINE Link].
Cho A, Eidelberg A, Butler DJ, Danko D, Afshinnekoo E, Mason CE, et al. Efficacy of Daily Intake of Dried Cranberry 500 mg in Women with Overactive Bladder: A Randomized, Double-Blind, Placebo Controlled Study. J Urol. 2021 Feb. 205 (2):507-513. [QxMD MEDLINE Link].
[Guideline] Nambiar AK, Arlandis S, Bø K, et al. European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence. Eur Urol. 2022 Jul. 82 (1):49-59. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Communication between urothelium and suburothelium. ACh—acetylcholine; ATP—adenosine triphosphate; M2—muscarinic receptor subtype 2; M3—muscarinic receptor subtype 3; NO—nitric oxide; P2X1—purinergic receptor P2X, ligand-gated ion channel 1; P2X3—purinergic receptor P2X, ligand-gated ion channel 3; sGC—soluble guanyl cyclase; VR1—vanilloid receptor 1.
Overactive bladder (OAB) and quality of life (QoL). Short Form-36 (SF-36). Reprinted with permission from Blackwell.
Total community and institutional costs of overactive bladder (OAB) (in millions of dollars). UTI—urinary tract infection (UTI). Reprinted with permission from Elsevier.

of 3

Author

Pamela I Ellsworth, MD Chief, Division of Pediatric Urology, Nemours Children's Hospital; Professor of Urology, University of Central Florida College of Medicine

Pamela I Ellsworth, MD is a member of the following medical societies: American Urological Association, Massachusetts Medical Society, Society for Fetal Urology, Society of Women in Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Wellman W Cheung, MD, FACS Clinical Professor, Department of Urology and Department of Obstetrics and Gynecology, State University of New York Downstate Medical School

Wellman W Cheung, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Chinese American Medical Society, Endourological Society, American Urogynecologic Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Received grant/research funds from Astallas for pi.

Aneela Naureen Hussain, MD, MBBS, FAAFM Consulting Staff, Department of Family Medicine, South Texas Veterans Health Care System in San Antonio

Aneela Naureen Hussain, MD, MBBS, FAAFM is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Medical Women's Association, Medical Society of the State of New York, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Nadia Hasan Khan, MD Family Medicine Physician, Dartmouth Hitchcock Clinics Milford

Nadia Hasan Khan, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Miriam T Vincent, MD, PhD, JD Professor and Chair, Department of Family Practice, State University of New York Downstate Medical Center

Miriam T Vincent, MD, PhD, JD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Bar Association, American Bar Association, American Academy of Family Physicians, Sigma Xi, The Scientific Research Honor Society, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Antares.

Additional Contributors

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoscopic and Robotic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

LiAnn N Handel, MD Resident Physician, Department of Urology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University

LiAnn N Handel, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Overactive Bladder Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?