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ABOG Urogynecology and Reconstructive Pelvic Surgery study materials
ABOG Urogynecology and Reconstructive Pelvic Surgery study resources

ABOG Urogynecology and Reconstructive Pelvic Surgery: Overactive Bladder and Lower Urinary Tract Dysfunction

ABOG Urogynecology and Reconstructive Pelvic Surgery · Work through your exam, one topic at a time.

All guide sections

Overactive Bladder and Lower Urinary Tract Dysfunction

Definitions

Overactive bladder (OAB) is urgency, with or without urgency incontinence, usually with frequency and nocturia, in the absence of infection or other pathology. Detrusor overactivity is the urodynamic finding. Distinguish OAB from interstitial cystitis/bladder pain syndrome (pain with filling), urinary tract infection, and bladder outlet obstruction.

Treatment ladder

First-line: behavioral modification, bladder training, pelvic floor muscle training, fluid/caffeine management, weight loss. Second-line: antimuscarinics (oxybutynin, tolterodine, solifenacin) or beta-3 agonist mirabegron. Third-line: intradetrusor onabotulinumtoxinA, sacral neuromodulation, percutaneous tibial nerve stimulation. Refractory or neurogenic cases may need augmentation cystoplasty or urinary diversion.

Traps

  • Treating OAB without excluding infection, stones, or malignancy (especially with hematuria).
  • Overlooking anticholinergic side effects (cognitive, constipation, dry mouth) in older adults.
  • Confusing urgency incontinence with SUI and treating with surgery.
  • Forgetting PVR monitoring before starting antimuscarinics.

Rule of thumb

Before escalating OAB therapy, confirm the diagnosis and address reversible causes (infection, diuretics, caffeine, constipation). Consider beta-3 agonists when anticholinergic burden is a concern.