Developing and Implementing an OAB Practice Algorithm-Developing and Implementing an OAB Practice Algorithm

Video Transcription

Video Summary

The speaker gave an overview of overactive bladder (OAB), emphasizing that it is common, chronic, and often requires stepwise treatment. He stressed the value of using a care pathway to improve patient education, follow-up, satisfaction, and access to later therapies. Initial evaluation is usually limited to history, physical exam, and urinalysis, with bladder diary and postvoid residual used when needed.<br /><br />First-line treatment includes behavioral changes, fluid management, avoiding bladder irritants, constipation treatment, pelvic floor physical therapy, and weight loss. Medication options include anticholinergics and beta-3 agonists. He highlighted anticholinergic side effects, especially dry mouth, constipation, and growing concern about cognitive effects and dementia risk, favoring more bladder-selective or CNS-sparing agents when possible.<br /><br />For refractory OAB, he reviewed three third-line therapies: tibial nerve stimulation, intradetrusor botulinum toxin, and sacral neuromodulation. He discussed their indications, benefits, risks, and practical considerations, including retention risk with Botox and MRI-compatible sacral devices. He also answered questions about diabetes-related bladder symptoms, anticoagulation, antibiotics, pregnancy considerations, and combining therapies.<br /><br />Overall, he concluded that OAB treatment should be individualized, shared with the patient, and adjusted over time.

Keywords

overactive bladder

OAB

behavioral therapy

anticholinergics

beta-3 agonists

botulinum toxin

sacral neuromodulation

tibial nerve stimulation