The Non-neurogenic Overactive Bladder: an Update

The objective of this study was to review the most recent literature to evaluate and analyse new information regarding the evaluation and treatment trends that is available.

The aetiology and pathophysiology for the non-neurogenic or idiopathic overactive bladder (OAB) remains unclear. Recent functional MRI studies of the brain indicate an age-related decrease in neurological control of continence of urine. Microbiomes in the urogenital tract have also been implicated in the aetiology of the OAB. The diagnosis and initial management should be based on a thorough history, examination and basic investigations to exclude treatable causes such as urinary tract infection (UTI) and malignant conditions. The first line of therapy is conservative with behavioural and pelvic floor muscle retraining and the addition of an information leaflet can add to a better outcome. However, there are still too few studies to evaluate the effect on urgency urinary incontinence (UUI). Electrical stimulation combined with pelvic floor muscle training (PFMT) treatment versus PFMT treatment alone is twice more likely to improve UUI. There is a recent trend towards mirabegron as the preferred choice of first-line pharmacotherapy versus anticholinergic treatment for OAB to avoid anticholinergic side effects. For the refractory cases, phase III trials with level 1 evidence make licencing of the use of 100 U of botulinum for the idiopathic OAB now possible. American Board of Urology (ABU)-certified urologists in the USA perform sacral neuromodulation (SNS) more commonly and very rarely augmentation cystoplasty.

The pathophysiology of the OAB remains unclear and further ongoing research is required. New trends of treatment are recognised for both conservative pharmacotherapy and refractory OAB.