© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
Alpha blockers
Thesemaybeused to treat LUTS (includingOAB) inmen
without obstruction due to BPH. This form of therapy
may relieve many OAB symptoms without the need for
anticholinergics.
Botox injection of the bladder wall
This has been successfully used in neurogenic OAB and
non-neurogenic OAB.
46,47
Recently, Botox injections into
the bladder have been approved by both the US Food
andDrugAdministrationandHealthCanada for patients
with neurogenic OAB associatedwithmultiple sclerosis
or spinal-cord injury. Botox injection has drawbacks,
including loss of effectiveness after 3 to9months, possible
spread of the toxin effects, and cost. Tachyphylaxis does
not appear to be a concern with Botox.
Other therapy
Neuromodulation, in the form of peripheral posterior
tibial nerve stimulation and sacral neuromodulation,
has been used in patients who have intractableOAB.
48-51
Conclusion
OAB is common and affects both men and women.
Patients can have OAB dry or OAB wet. In most cases,
a patient history including a short voiding diary, a
physical examination, and some simple blood and
urine tests are all that are needed to diagnose a patient
with OAB and begin treatment for this condition. A
combination of behavioral therapy plus medication (an
anticholinergic agent), which is easily and appropriately
initiated by the primary care physician, is the best
initial treatment. If this treatment fails, then the patient
should be referred to a urologist, urogynecologist, or
geriatricianwho specializes inOAB. At that point, more
sophisticated tests such as cystoscopy or urodynamics
may be considered, and patient management may
require more advanced treatments.
Disclosure
Dr. SidneyB. Radomski is onadvisoryboards forAstellas,
Pfizer, Allergan and Lilly.
Dr. Jack Barkin has been a clinical investigator, speaker
and medical advisory board member and consultant
forAbbott, Lilly, Bayer, Paladin, Watson Pharma, Bayer,
AstraZeneca , Astellas, Solvay, Pfizer and Triton.
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