What treatment should we use if drugs fail for OAB; and, what really works after drugs?
OBJECTIVE
To determine (using structured brain storm sessions), which treatments should be used if drugs fail for OAB and to determine priority research questions in relation to this issue.


METHODS
A frame work for discussion was prepared by the chairman of the session; this included a brief summary of the currently existing evidence. Several experts had been asked to prepare a presentation of their personal treatment algorithm and to identify the [lack of] evidence for such an algorithm. These presentations were summarized by the chairman. Next, this summary was discussed with a large group of experts and opinion leaders and audio-recorded. The proceedings of this process are the basis for this manuscript.


RESULTS
The structured sessions resulted in detailed statements about: possible reasons for failure of conservative treatment, the evaluation of outcomes of RCT's, the use of botulinum toxin A in refractory OAB patients, the relative place of neuromodulation or sacral nerve stimulation and botulinum toxin A in the treatment of refractory OAB.


CONCLUSIONS
A list of 10 unanswered questions and research topics was compiled. Additionally, 5 top priority research topics were identified.
Bosch
J L H R
JL
Department of Urology, University Medical Centre Utrecht, Utrecht, the Netherlands. j.l.h.r.bosch@umcutrecht.nl
Kelleher
C
C
van Kerrebroeck
P E V
PE
Schurch
B
B
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017211:Treatment Failure; D001743:Urinary Bladder / Q000187:drug effects* / Q000294:innervation; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000503:physiopathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A