Princess Alexandra Hospital, Brisbane, QLD
St George Hospital, Sydney, NSW.
Med J Aust. 2018 Jan 15;208(1):41-45. doi: 10.5694/mja16.01097.
Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.
膀胱过度活动症（OAB）是一种高发的医学病症，对多种与健康相关的生活质量领域都有不良影响，包括显著的心理社会和经济负担。本立场声明由澳大利亚和新西兰泌尿学会和澳大拉西亚泌尿妇科协会成员制定，总结了目前对非神经源性 OAB 患者的临床诊断和治疗策略的建议，并为临床医生提供了使用循证医学来管理该病症的决策过程的指导。主要建议：诊断和初始管理应基于全面的临床病史、检查和基本检查，以排除潜在的可治疗原因，如尿路感染和泌尿系统恶性肿瘤。OAB 的初始治疗策略包括保守管理，即行为改变和膀胱再训练。二线治疗包括使用抗胆碱能药物或β3 激动剂药物的医学治疗，前提是对膀胱排空进行充分评估。如果医学治疗不成功，建议进一步进行尿动力学研究和膀胱尿道镜检查，以指导进一步的治疗。对于药物难治性 OAB，可以考虑膀胱内肉毒杆菌毒素和骶神经调节。由于本声明，管理发生变化：OAB 是一组尿症状，是一种慢性疾病，治愈的可能性较低；管理患者的期望至关重要，因为 OAB 难以治疗。目前，OAB 的确切发病机制仍不清楚，这种疾病可能涉及多种因素。目前的医学治疗远不理想，尽管微创手术可能有效。对这种常见病症的病理生理学的进一步研究有望指导未来疾病管理的发展。
