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How to define a refractory idiopathic overactive bladder?

Véronique Phé1, Stefan de Wachter, Morgan Rouprêt

  • 1Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Paris 6 University, Paris, France.

Neurourology and Urodynamics
|October 25, 2013
PubMed
Summary
This summary is machine-generated.

Defining refractory idiopathic overactive bladder (IOAB) is complex, with current definitions lacking patient-centered outcomes. A clearer definition is needed to guide timely treatment with therapies like sacral neuromodulation.

Keywords:
antimuscarinicsbotulinum toxinfailureneuromodulationoveractive bladderrefractorysuccess

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Area of Science:

  • Urology
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Idiopathic overactive bladder (IOAB) presents a significant clinical challenge.
  • Current treatment paradigms often struggle with defining refractory cases, impacting therapeutic decisions.

Purpose of the Study:

  • To critically analyze the diverse definitions of "refractory" idiopathic overactive bladder (IOAB) in the scientific literature.
  • To evaluate the suitability of existing criteria for defining treatment success and failure in IOAB management.

Main Methods:

  • A comprehensive literature review was performed using PubMed and Cochrane Library databases.
  • Studies evaluating posterior tibial nerve stimulation, sacral neuromodulation, and botulinum toxin-A for IOAB were analyzed.
  • Primary endpoints and definitions of refractory IOAB were compared across studies.

Main Results:

  • Significant discrepancies exist in the literature regarding the definition of refractory IOAB.
  • Clinical trial endpoints for antimuscarinic success are not always applicable to daily practice or capture patient-centered outcomes.
  • Factors contributing to treatment failure include lack of efficacy, side effects, contraindications, patient willingness, and unmet expectations.

Conclusions:

  • A precise definition of refractory IOAB is complex and requires the integration of subjective patient-reported outcomes and objective measurements.
  • Incorporating patient expectations and quality of life assessments is crucial for a comprehensive definition.
  • Standardizing the definition of refractory IOAB is essential for appropriate and timely application of alternative therapies.