The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)

2024-05-20

GUIDELINE STATEMENTS

Evaluation/Diagnosis

1、In the initial office evaluation of patients presenting with symptoms suggestive of OAB, clinicians should:

    a.obtain a medical history with comprehensive assessment of bladder symptoms,

    b.conduct a physical examination, and

    c.perform a urinalysis to exclude microhematuria and infection.

    d.(Clinical Principle)

2、Clinicians may offer telemedicine to initially evaluate patients with symptoms suggestive of OAB, with the understanding that a physical exam will not be performed and urinalysis should be obtained at a local laboratory (or recent lab results reviewed, if available). (Expert Opinion)

3、Clinicians may obtain a post-void residual in patients with symptoms suggestive of OAB to exclude incomplete emptying or urinary retention, especially in patients with concomitant voiding or emptying symptoms. (Clinical Principle)

4、Clinicians may obtain a symptom questionnaire and/or a voiding diary in patients with symptoms suggestive of OAB to assist in the diagnosis of OAB, exclude other disorders, ascertain the degree of bother, and/or evaluate treatment response. (Clinical Principle)

5、Clinicians should not routinely perform urodynamics, cystoscopy, or urinary tract imaging in the initial evaluation of patients with OAB. (Clinical Principle)

6、Clinicians may perform advanced testing, such as urodynamics, cystoscopy, or urinary tract imaging in the initial evaluation of patients with OAB when diagnostic uncertainty exists. (Clinical Principle)

7、Clinicians should assess for comorbid conditions in patients with OAB that may contribute to urinary frequency, urgency, and/or urgency urinary incontinence and should educate patients on the role that managing these conditions can have on bladder symptoms. (Expert Opinion)

8、Clinicians may use telemedicine for follow-up visits with patients with OAB. (Expert Opinion)

Shared Decision-Making

9、Clinicians should engage in shared decision-making with patients with OAB taking into consideration the patient’s expressed values, preferences, and treatment goals in order to help them make an informed decision regarding different treatment modalities or to explore the option of no treatment. (Clinical Principle)

Non-Invasive Therapies

10、Clinicians should discuss incontinence management strategies (e.g., pads, diapering, barrier creams) with all patients who have urgency urinary incontinence. (Expert Opinion)

11、Clinicians should offer bladder training to all patients with OAB. (Strong Recommendation; Evidence Level: Grade A)

12、Clinicians should offer behavioral therapies to all patients with OAB. (Clinical Principle)

13、Clinicians may offer select non-invasive therapies to all patients with OAB. (Clinical Principle)

14、In patients with OAB whose symptoms do not adequately respond to monotherapy, clinicians may combine one or more of the following: behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies. (Expert Opinion)

15、Clinicians should counsel patients that there is currently insufficient evidence to support the use of nutraceuticals, vitamins, supplements, or herbal remedies in the treatment of OAB. (Expert Opinion)

Pharmacology

16、Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence. (Strong Recommendation; Evidence Level: Grade A)

17、Clinicians should counsel patients with OAB on the side effects of all oral medication options; treatment should be chosen based on side effect profiles and in the context of shared decision-making. (Clinical Principle)

18、Clinicians should discuss the potential risk for developing dementia and cognitive impairment with patients with OAB who are taking, or who are prescribed, antimuscarinic medications. (Clinical Principle)

19、Clinicians should use antimuscarinic medications with extreme caution in patients with OAB who have narrow-angle glaucoma, impaired gastric emptying, or a history of urinary retention. (Clinical Principle)

20、Clinicians should assess patients with OAB who have initiated pharmacotherapy for efficacy and onset of treatment side effects. (Expert Opinion)

21、In patients with OAB who experience intolerable side effects or who do not achieve adequate improvement with an OAB medication, clinicians may offer a different medication in the same class or different class of medication to obtain greater tolerability and/or efficacy. (Clinical Principle)

22、In patients with OAB who do not achieve adequate improvement with a single OAB medication, clinicians may offer combination therapy with a medication from a different class. (Conditional Recommendation; Evidence Level: Grade B)

Minimally Invasive Procedures

23、Clinicians may offer minimally invasive procedures to patients with OAB who are unable or unwilling to undergo behavioral, non-invasive, or pharmacologic therapies. (Clinical Principle)

24、Clinicians may offer patients with OAB, in the context of shared decision-making, minimally invasive therapies without requiring trials of behavioral, non-invasive, or pharmacologic management. (Expert Opinion)

25、In patients with OAB who have an inadequate response to, or have experienced intolerable side effects from, pharmacotherapy or behavioral therapy, clinicians should offer sacral neuromodulation, percutaneous tibial nerve stimulation, and/or intradetrusor botulinum toxin injection. (Moderate Recommendation; Evidence Level: Grade A)

26、Clinicians should measure post-void residual in patients with OAB prior to intradetrusor botulinum toxin injection. (Clinical Principle)

27、Clinicians should obtain a post-void residual in patients with OAB whose symptoms have not adequately improved or have worsened after intradetrusor botulinum toxin injection. (Clinical Principle)

28、Clinicians should discontinue oral medications in patients with OAB who have an appropriate response to a minimally invasive procedure but should restart pharmacotherapy if efficacy is not maintained. (Expert Opinion)

29、Clinicians may perform urodynamics in patients with OAB who do not adequately respond to pharmacotherapy or minimally invasive therapies to further evaluate bladder function and exclude other disorders. (Clinical Principle)

Invasive Therapies

30、The clinician may offer bladder augmentation cystoplasty or urinary diversion in severely impacted patients with OAB who have not responded to all other therapeutic options. (Expert Opinion)

Indwellling Catheters

31、Clinicians should only recommend chronic indwelling urethral or suprapubic catheters to patients with OAB when OAB therapies are contraindicated, ineffective, or no longer desired by the patient and always in the context of shared decision-making due to risk of harm. (Expert Opinion)

OAB and BPH

32、The clinician may offer patients with BPH and bothersome OAB, in the context of shared decision-making, initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies. (Expert Opinion)

33、Clinicians may offer patients BPH and OAB monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist. (Conditional Recommendation; Evidence Level: Grade B)