RESUMEN
CONTEXT: A considerable number of patients affected by the overactive bladder syndrome (OAB) do not respond to pharmacotherapy and bladder training due to unsatisfactory response or intolerability. OBJECTIVE: To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. EVIDENCE ACQUISITION: PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. EVIDENCE SYNTHESIS: Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. CONCLUSIONS: None of the mentioned therapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. PATIENT SUMMARY: In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns.
Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Tratamiento Conservador/efectos adversos , Estimulación Eléctrica Transcutánea del Nervio/métodos , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Administración Intravesical , Algoritmos , Toxinas Botulínicas Tipo A/uso terapéutico , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Resistencia a Medicamentos , Terapia por Estimulación Eléctrica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fármacos Neuromusculares/uso terapéutico , Prioridad del Paciente , Sacro/inervación , Nervio Tibial/fisiología , Estimulación Eléctrica Transcutánea del Nervio/estadística & datos numéricos , Insuficiencia del Tratamiento , Vejiga Urinaria Hiperactiva/economía , Vejiga Urinaria Hiperactiva/epidemiología , Vejiga Urinaria Hiperactiva/terapiaRESUMEN
PURPOSE OF REVIEW: Overactive bladder affects 10-12% of men, of which 13% are refractory to medical therapy and seek second-line treatment. This places a substantial clinical and economic burden on the National Health Service United Kingdom. RECENT FINDINGS: This review identifies current evidence for the use of onabotulinum toxin A and sacral nerve neuromodulation for the treatment of overactive bladder in patients who do not respond to optimal medical treatment. Posterior tibial nerve stimulation is not covered here. Clinical and financial implications of the treatments are reviewed. SUMMARY: The focus will remain on recently published evidence, which may be useful to clinicians managing refractory patients.