title: How to define a refractory idiopathic overactive bladder?
abstract: OBJECTIVE
  To present the different definitions of "refractory" IOAB.
  
  
  METHODS
  A review of the literature based on PubMed and Cochrane library databases has been conducted. The criteria for defining the success or failure of antimuscarinic treatment and the different definitions of refractory IOAB used in studies evaluating the effects of posterior tibial nerve stimulation, sacral neuromodulation and intradetrusor botulinum toxin-A injections, have been presented. The primary endpoints of these studies were compared. Additionally, different definitions of refractory IOAB were retrieved.
  
  
  RESULTS
  There are discrepancies in the definition of "refractory" IOAB in the literature. The definitions of antimuscarinic success in clinical trials are not always transposable into daily practice. Moreover, these clinical trial endpoints do not explore the entirety of a meaningful patient-centered outcome. The failure of antimuscarinic treatments may be defined by different factors, including lack and loss of efficacy, intolerance to side effects, contraindications, willingness of patients to go further with treatment and inadequacy of patient's expectations. Ideally, the best functional outcomes would assess patient's expectations and the physician's objectives and objective measurements. Finally, assessing quality of life might be the most reliable outcome to measure, by considering of all the discussed data.
  
  
  CONCLUSIONS
  An appropriate definition is complex and needs to consider subjective tools. The "refractory" IOAB needs to be more specifically defined so that alternative treatments can be used at the appropriate time.
authors.affiliation: Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Paris 6 University, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.forename: Stefan
authors.initials: S
authors.lastname: de Wachter
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
mesh_terms: D006801:Humans; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
keywords: antimuscarinics; botulinum toxin; failure; neuromodulation; overactive bladder; refractory; success