Schwantes Ulrich, Grosse Joachim, Wiedemann Andreas
Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, 96045, Bamberg, Germany.
Urological Clinic, University Clinic Aachen, 52074, Aachen, Germany.
Int Urogynecol J. 2015 Oct;26(10):1407-14. doi: 10.1007/s00192-015-2674-0. Epub 2015 Mar 20.
Unsatisfactory treatment outcome sometimes is described as frequently occurring in patients treated with first-line therapy for overactive bladder (OAB). The present article reviews the different circumstances which may result in failure to respond to lifestyle interventions, behavioral therapy, and/or antimuscarinic treatment.
An extensive literature search was conducted to identify relevant articles on pathophysiological, clinical, and pharmacological aspects of refractory OAB.
Missing definition, unrealistic individual expectation of treatment outcomes, lack of communication between physician and patient as well as pathophysiological and pharmacological processes were identified as relevant for failure to respond to first-line OAB treatment. Increase of patient's motivation to adhere to the prescribed treatment, critical examination of the patient in regard to the initial diagnosis, and individual adjustment of antimuscarinic therapy may be appropriate tools to improve treatment outcome in OAB patients.
Overall, the incidence of refractory OAB seems to be overestimated. There are several approaches to improve therapy results.
膀胱过度活动症（OAB）一线治疗的患者有时会出现治疗效果不理想的情况。本文回顾了可能导致对生活方式干预、行为疗法和/或抗胆碱能治疗无反应的不同情况。
进行了广泛的文献检索，以确定有关难治性OAB的病理生理、临床和药理学方面的相关文章。
未明确的定义、对治疗结果不切实际的个人期望、医患之间缺乏沟通以及病理生理和药理过程被确定为与一线OAB治疗无反应相关的因素。提高患者坚持规定治疗的动机、对患者初始诊断进行批判性检查以及对抗胆碱能治疗进行个体化调整可能是改善OAB患者治疗效果的合适方法。
总体而言，难治性OAB的发生率似乎被高估了。有几种方法可以改善治疗效果。
