Editing Functional: Overactive Bladder (section)

== Initial treatment outline ==

* '''See 2017 CUA OAB Guideline Notes'''
* '''Options:'''
*# '''Observation'''
*# '''Conservative'''
*# '''Pharmacological'''
*# '''Surgical'''

=== Observation ===
* After assessment has been performed to exclude conditions requiring treatment and counseling, “no treatment” is an acceptable choice made by some patient

=== Conservative ===
* '''Weight loss'''
* '''Smoking cessation'''
* '''Diet modification (decreased use of caffeine, decreased fluid intake, decreased alcohol intake, changes in food and drink'''
* '''Pelvic floor muscle training''', to resist and occasionally to terminate overactivity when it arises
* '''Bladder retraining''' to encourage inhibitory influences on the lower urinary tract
** These treatments need to be attempted for at least 6 weeks to obtain benefit, and they should ideally be tried for 3 months.

=== Pharmacological ===
* '''If conservative treatment fails, the patient can then be offered antimuscarinic therapy if there are no contraindications.'''
**Avoid use in patients with 
***Narrow-angle glaucoma unless approved by ophthalmologist
***Impaired gastric emptying
***History of urinary retention
**Cognitive impairment should be considered prior to prescribing antimuscarinics 
* At least 2 antimuscarinics must be tried for at least 4 weeks each, starting at a low dose and building up to a maximum dose.
** Incidence of acute urinary retention in men receiving antimuscarinics with or without an α1-adrenergic blocker is up to 3%.
* If patients are unable to tolerate antimuscarinics or the antimuscarinics have failed to control symptoms, then patients can be prescribed mirabegron.

=== Surgical ===
* If conservative and medical therapies fail to control symptoms and the patient requires further treatment, invasive urodynamics is then performed to confirm DO and/or detrusor overactivity incontinence, and minimally invasive surgery, where indicated and available is offered.
* Options:
** Intradetrusor injections of botulinum toxin-A
** Percutaneous sacral nerve stimulation
** Percutaneous tibial nerve stimulation.
** Other options include augmentation cystoplasty, in its various forms, or an ileal conduit with or without a subtotal cystectomy. In adults, augmentation is no longer recommended for the treatment of detrusor overactivity because the long-term success of this procedure is not high.