Combining antimuscarinic drugs and behavioral interventions may produce more benefits than either approach alone. If one antimuscarinic drug causes unacceptable adverse effects, switch to a different antimuscarinic drug before abandoning antimuscarinic therapy.
Consider referring a patient to a specialist if he or she has failed behavioral therapy and has failed an antimuscarinic medication administered for 6-12 weeks.
Third-line treatments for OAB include SNS, PTNS, and intradetrusor onabotulinumtoxinA injections. These therapies may be offered to patients who have severe symptoms that have been refractory to behavioral and medication therapy.
Indwelling catheters are not recommended to manage OAB because of the high rates of adverse events associated with indwelling catheterization.
Surgery for OAB is appropriate only in the extremely rare patient.
Reference
• Gormley, E.A., et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. J. Urol. 2012;188:2455-63.
Dr. Alexander is an assistant professor of internal medicine and pediatrics, and associate program director of the med-peds residency at the University of Arkansas, Little Rock. Dr. William E. Golden, editor of this column, is medical director of Arkansas Medicaid and professor of medicine and public health at the University of Arkansas. Dr. Robert H. Hopkins, editor of this column, is director of the division of general internal medicine at the University of Arkansas. E-mail them at imnews@frontlinehealthcom.com. They reported having no relevant financial conflicts. This column, "The Effective Physician," appears regularly in Internal Medicine News.