What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making.

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Timestamps

00:00 - Introduction
03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline
07:32 - Patient Experience with OAB
11:59 - Beta-3 Agonists vs Anticholinergics
15:15 - Botox Counseling and Dosing
18:11 - Tibial Nerve Stimulation
25:47 - Sacral Neuromodulation
32:09 - Cost Burden of OAB
39:38 - Evolution of OAB Care
41:39 - Future Research Directions

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More about this episode

The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently.

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Resources

The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)
https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

Anticholinergic Drug Exposure and the Risk of Dementia
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial

https://pubmed.ncbi.nlm.nih.gov/20171677/

Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registry
https://www.auajournals.org/doi/10.1097/UPJ.0000000000000916

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?
https://pubmed.ncbi.nlm.nih.gov/33197059/