title: The evaluation and management of refractory neurogenic overactive bladder.
abstract: Patients with neurologic disease commonly develop overactive bladder (OAB) symptoms of urgency, frequency, and/or urge incontinence that remain bothersome despite oral pharmacologic therapy. Management of refractory OAB in the neurogenic population is a complex issue with no uniform treatment strategy. When treatment fails or patients generally are dissatisfied with the adverse effects of oral therapy, available options include sacral neuromodulation, percutaneous tibial nerve stimulation (PTNS), botulinum toxin injections, and lower urinary tract reconstruction such as augmentation cystoplasty. A thorough knowledge and understanding of available and emerging treatment options for neurogenic detrusor overactivity is paramount to assisting clinicians in choosing an appropriate treatment. This article reviews the non-pharmacologic treatment options for neurogenic OAB, mainly botulinum toxin, neuromodulation, and lower urinary tract reconstruction, and discusses important relevant studies.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, USA, rkurpad@unch.unc.edu.
authors.forename: Raj
authors.initials: R
authors.lastname: Kurpad
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kennelly
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004599:Electric Stimulation Therapy; D006801:Humans; D008160:Lumbosacral Plexus; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures; D013979:Tibial Nerve; D017211:Treatment Failure; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000628:therapy*; D014563:Urodynamics
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A