The medical management of refractory overactive bladder

Overactive Bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Those women with refractory or intractable symptoms following initial conservative and antimuscarinic medication may benefit from further assessment and investigation of their symptoms prior to considering different approaches to drug therapy. This review is the first of two to cover the management of intractable OAB in women and provides a practical clinical approach to managing women with refractory OAB symptoms. This paper covers the investigation and medical management of this demanding patient group whilst the second paper will focus on the role of more invasive treatments such as Botulinum Toxin, neuromodulation and reconstructive surgery.