title: What treatment should we use if drugs fail for OAB; and, what really works after drugs?
abstract: 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.
authors.affiliation: Department of Urology, University Medical Centre Utrecht, Utrecht, the Netherlands. j.l.h.r.bosch@umcutrecht.nl
authors.forename: J L H R
authors.initials: JL
authors.lastname: Bosch
authors.forename: C
authors.initials: C
authors.lastname: Kelleher
authors.forename: P E V
authors.initials: PE
authors.lastname: van Kerrebroeck
authors.forename: B
authors.initials: B
authors.lastname: Schurch
mesh_terms: 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
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A