Current management of overactive bladder.
OBJECTIVE
The concept of overactive bladder has helped us address the problem of urgency and urge incontinence from a symptomatic perspective. In this review, we provide a critical summary of clinically relevant recent publications, focusing in particular on advances in our understanding of assessment methods and therapeutic interventions for overactive bladder in women.


RESULTS
According to current definitions, the prevalence of overactive bladder in western nations is now estimated as 13.0%. Although the prevalence increases with age, the symptoms of overactive bladder may follow a relapsing and remitting course. There has been a proliferation of validated symptom and quality of life measures and increasing sophistication in the analysis of bladder diaries. The role of urodynamics in the evaluation of urgency remains uncertain, with many trials showing limited benefit as a preoperative investigation. Fluid restriction and bladder retraining remain important first-line interventions. Many new anticholinergic medications have been licensed, with limited benefits compared with existing preparations. Intravesical botulinum toxin has become a popular alternative for patients who fail oral therapies.


CONCLUSIONS
Although there have been few important therapeutic innovations, recent publications have led to greater sophistication in assessment methods and a clearer understanding of the role of existing interventions.
Cartwright
Rufus
R
Department of Urogynaecology, King's College Hospital, Denmark Hill, London, UK. rufus.cartwright@gmail.com
Renganathan
Arasee
A
Cardozo
Linda
L
D001905:Botulinum Toxins / Q000633:toxicity; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D015995:Prevalence; D011788:Quality of Life; D001743:Urinary Bladder / Q000473:pathology; D001745:Urinary Bladder Diseases / Q000188:drug therapy; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000453:epidemiology*; D053202:Urinary Incontinence, Urge / Q000188:drug therapy; D014563:Urodynamics; D014572:Urology / Q000379:methods*
D018680:Cholinergic Antagonists; D001905:Botulinum Toxins