• Arun Sahai, Mo Belal, Rizwan Hamid, Phillip Toozs-Hobson, Paraskeve Granitsiotis, and Dudley Robinson.
• Consultant Urologist, Guy's and St Thomas' Hospital, London, UK.
• Int. J. Clin. Pract. 2021 Apr 1; 75 (4): e13847.

PurposeOveractive Bladder (OAB) is a common condition that is known to have a significant impact on Health Related Quality of Life (HRQoL). Whilst all patients will initially benefit from lifestyle modifications and behavioural therapy in the first instance drug therapy remains integral in management pathways. The purpose of this review paper is to reappraise the evidence based approach to the management of OAB in addition to exploring a new treatment algorithm for the escalation of treatment in those patients with refractory symptoms.DesignLiterature Review RESULTS: Antimuscarinic drugs are currently the most commonly used medication although the introduction of mirabegron, a β3 agonist, has provided an alternative and also allowed combination therapy in those patients who have failed to improve on primary therapy or who have troublesome side effects. For those patients with symptoms of refractory OAB more invasive therapies including OnabotulinumtoxinA, sacral neuromodulation and Percutaneous Tibial Nerve Stimulation (PTNS) may be indicated.ConclusionWe propose a new, evidence based, treatment algorithm for the management of OAB in patients who remain refractory to first line therapy.© 2020 John Wiley & Sons Ltd.

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