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Antimuscarinic drug Level of evidence Grade of recommendation

Tolterodine 1 ATrospium 1 ASolifenacin 1 ADarifenacin 1 APropantheline 2 BAtropine, hyoscyamine 3 C

Drugs with mixed actionsOxybutynin 1 APropiverine 1 ADicyclomine 3 CFlavoxate 2 D

AntidepressantsImipramine 3 C

Alpha-AR antagonistsAlfuzosin 3 CDoxazosin 3 CPrazosin 3 CTerazosin 3 CTamsulosin 3 C

Beta-AR antagonistsTerbutaline 3 CSalbutamol 3 C

COX-inhibitorsIndomethacin 2 CFlurbiprofen 2 C

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*intrathecal; **intravesical; ***bladder wall; ****nocturia

� 2. EBM (ICI assessment 2004: Oxford guidelines (modified))[AnderssonKE, 2004]

Levels of evidenceLevel 1: Systematic reviews, meta-analyses, good quality randomizedcontrolled clinical trials (RCTs)Level 2: RCTs, good quality prospective cobort studiesLevel 3: Case-control studies, case seriesLevel 4: Expert opinion

Grades of recommendationGrade A: Based on level 1 evidence (highly recommended)Grade B: Consistent level 2 or 3 evidence (recommended)Grade C: Level 4 studies or “majority evidence” (optional)Grade D: Evidence inconsistent/inconclusive (no recommendation possible)

NNS

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PVR > 100 mls and/or reduced flowrate and/or bladder emptying symptoms

Life style modification/bladder training/BiofeedbackElectrical stimulation/magnetic field stimulation/oral medication

Failure to improveafter initial treatment

Evaluate bladder capacity

Urodynamics:Uroflowmetry/cystometry/Electromyography/videoUDS/cystoscopy

Specialized managementNeuromodulationIntravesical vanilloids (under investigation)Botulinum toxin treatment (under investigation)Urinary diversionBladder augmentation/substitution

Success to improveafter initial treatment

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OAB No Yes

� 2. Evaluation and management of overactive bladder.

� 4. Drug therapy forms the basis of treatment for overactive bladder (OAB)

Generic Name Trade Name Available Doses Mode of Delivery

Oxybutynin Chloride Cystrin; Ditropan IR: 2.5 mg; 3 mg; 5 mg OralLyrinel XL ER: 5 mg, 10 mg, 5 mg OralOxytrol 36 mg/patch (3.9 mg/d) Transdermal

Tolterodine Tartrate Detrusitol; Detrol LA IR: 1 mg or 2 mg OralDetrusitol XL ER: 2 mg, 4 mg Oral

Trospium Chloride Regurin; Sanctura 20 mg OralPropiverine Hydrochloride Detrunorm 15 mg OralSolifenacin Succinate Vesicare 15 mg or 10 mg Oral

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tive bladder. BJU Int 2007; 100:987-1006.

Abrams P, Hanno P, Wein A: Overactive bladder and painful bladder

syndrome: There need not be confusion. Neurourol Urodyn 2005; 24:

149-150.

Abrams P, Klevmark B: Frequency volume charts: An indispensable part

of lower urinary tract assessment. Scand J Urol Nephrol Suppl 1996;

179:47-53.Andersson KE: New pharmacologic targets for the treatment of the over-

active bladder: An update. Urology 2004; 63(3 Suppl 1):32-41.

Baily R, Shepherd A, Tribe B: How much information can be obtained

from frequency/volume charts? Neurourol Urodyn 1990; 9:382-383.

Cardozo L: The overactive bladder syndrome: Treating patients on an

individual basis. BJU Int 2007; 99(Suppl 3):1-7.

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toms after discontinuation of successful 3-month treatment with an

antimuscarinic agent: A prospective trial. J Urol 2005; 174:201-204.

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search and Practice: Based on our meeting at the IUGA/ICS Joint

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� 3. Management of overactive bladder.

Overactive bladder

Life style interventionsBladder trainingBiofeedbackElectrical stimulation/magnetic field stimulationoral medication

Specialized management:NeuromodulationIntravesical vanilloids (under investigation)Botulinum toxin treatment (under investigation)Urinary diversionBladder augmentation/substitution

Complete treatmentcourse/maintain

failed success

NNU

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Lavelle JP, Karram M, Chu FM, et al: Management of incontinence for

family practice physicians. Am J Med 2006; 119(3 Suppl 1):37-40.

Matza LS, Thompson CL, Krasnow J, Brewster-Jordan J, Eycynski T,

Coyne KS: Test-retest reliability of four questionnaires for patients with

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patient perception of bladder condition (PPBC), urgency questionnaire

(UQ), and the primary OAB symptom questionnaire (POSQ). Neurourol

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Gynecol Obstet Fertil 2008; 36:90-96.

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quency-volume chart: The minimum number of days required to ob-

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pathophysiology, diagnosis and management. J Urol 2006; 175:S5-

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Yamaguchi O, Marui E, Kakizaki H, et al: Randomized, double-blind,

placebo- and propiverine-controlled trial of the once-daily antimuscarinic

agent solifenacin in Japanese patients with overactive bladder. BJU

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continence in patients with overactive bladder. J Urol 2005; 173:1639-

1643.

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