title: Overactive bladder syndrome: Current pathophysiological concepts and therapeutic approaches.
abstract: OBJECTIVE
  The overactive bladder syndrome (OAB) is a highly prevalent and bothersome symptom complex. We review contemporary reports to provide an update of the key aspects of its pathogenesis and the therapeutic approaches.
  
  
  METHODS
  The PUBMED database was searched for relevant publications in the period from 1 January 1985 to 1 May 2013, using the keywords 'overactive bladder', 'anti-muscarinics', 'β-3 agonists', 'intravesical botulinum toxin', 'tibial nerve stimulation and 'sacral neuromodulation'.
  
  
  RESULTS
  In all, 33 articles were selected for this review. OAB is very common, affecting 10-20% of the population. It is often bothersome and frequently affects the quality of life. The current definition of OAB remains a source of controversy. Anti-muscarinic agents remain the mainstay of pharmacotherapy. The new β-3 agonists have some efficacy whilst avoiding anti-cholinergic effects, and so might benefit patients who are unable to tolerate anti-muscarinic agents. Intravesical botulinum toxin is recommended for patients in whom oral pharmacotherapy fails, although the optimal parameters in terms of dosing, number of injections and injection site are yet to be fully established. Sacral neuromodulation is another option that has a good response in about half of patients.
  
  
  CONCLUSIONS
  OAB remains an incompletely understood problem that presents a significant management challenge. A range of therapeutic options is now available for clinicians managing this problem.
authors.affiliation: Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Nadir I
authors.initials: NI
authors.lastname: Osman
authors.affiliation: Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
keywords: AM, antimuscarinic agent; Antimuscarinics; BTX, botulinum toxin A; Botulinum toxin; DO, detrusor overactivity; ER, extended-release; Mirabegron; OAB, overactive bladder syndrome; Overactive bladder; PTNS, posterior tibial nerve stimulation; SNM, sacral neuromodulation