[What to do if pills do not work for urge incontinence--still many questions and ambiguities].
Bladder training and antimuscarinics are first-line treatments for the symptoms of an overactive bladder. Unfortunately, many patients stop using drugs due to undesirable effects or limited efficacy. The paper by Smits et al. contains a summarisation of various neuromodulation treatments that can be offered to patients after first-line treatments have failed, e.g. sacral neuromodulation, posterior tibial nerve stimulation, pudendal neuromodulation and intravesical botulinum toxin A. An unambiguous treatment algorithm based on RCTs is lacking at this time; however, postulation of a patient's profile is possible. Research in the field of dysfunctional voiding should focus on comparing the different treatment options in order to create an algorithm based on science.
Catharina Ziekenhuis, afd. Urologie, Eindhoven, the Netherlands. evert.koldewijn@catharinaziekenhuis.nl
Evert L
EL
Koldewijn
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004599:Electric Stimulation Therapy; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000628:therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A