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Detrusor Underactivity Model in Rats by Conus Medullaris Transection

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Third-line therapy for overactive bladder in the elderly: Nuances and considerations.

Jacqueline Zillioux¹, Emily A Slopnick¹, Sandip P Vasavada¹

¹Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Neurourology and Urodynamics

|June 1, 2022

Summary

Third-line therapies for overactive bladder (OAB) are effective and safe for older adults. Treatment decisions for refractory OAB should be individualized, considering patient frailty and shared decision-making.

Keywords:

elderly neuromodulation onabotulinumtoxinA overactive bladder

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Published on: August 18, 2014

Area of Science:

Geriatrics
Urology
Pharmacology

Background:

Overactive bladder (OAB) significantly impacts older adults, presenting challenges with pharmacotherapy due to polypharmacy, side effects, comorbidities, and dementia risk.
Nonpharmacologic therapies are crucial, but aging factors can affect treatment efficacy and decision-making.

Purpose of the Study:

To critically review evidence on third-line OAB therapies in the elderly.
To discuss specific treatment considerations and nuances for this population.

Main Methods:

A nonsystematic evidence assessment of literature from PubMed was conducted.
Focus was placed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) in elderly and frail populations.

Main Results:

All three third-line therapies (BTX-A, sacral neuromodulation, PTNS) demonstrate efficacy in older OAB patients.
BTX-A may carry a higher risk of urinary tract infection and retention in the elderly, particularly the frail.
Percutaneous tibial nerve stimulation (PTNS) has the lowest risk but faces adherence challenges due to logistical burdens.

Conclusions:

Advanced age and frailty should not be barriers to considering third-line therapy for refractory OAB.
Available data support the efficacy and safety of these treatments in older adults.
Individualized treatment choices and shared decision-making are paramount.