Overactive bladder (OAB) is a highly prevalent condition affecting up to 40% of women and 20%of men. More than a decade ago, the American Urological Association (AUA), in partnership with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), issued its first set of guidelines for diagnosing and treating OAB. In 2024, the AUA/SUFU presented its fourth iteration with a change in perspective on treatment planning that not only incorporates evidence‐based recommendations, but also the values and preferences of patients.
Doreen E. Chung MD, FRCSC, a urologist at NewYork-Presbyterian and Columbia specializing in urinary incontinence, served as a member of the select national panel of clinical experts who developed the 2024 AUA/SUFU guideline. Below, Dr. Chung highlights the key updates and recommendations in the revised guidelines for the diagnosis and treatment of OAB.
Guideline Background
OAB is a highly prevalent condition that can negatively impact a patient's quality of life. Overall, there has been a lack of consensus on how to evaluate patients with OAB and manage those with refractory symptoms. The AUA/SUFU guideline is designed to inform and bring awareness to clinicians from all specialties of the many treatment options available for OAB and how to facilitate the decision-making process.
The guideline stresses shared decision‐making between the patient and physician to identify the therapy that best meets the patient’s individual circumstances, clinical needs, and preferences.
— Dr. Doreen Chung
Guideline Structure
We organized the guideline by eight umbrella categories and delineated with a total of 33 statements that address:
- Evaluation and diagnosis
- Shared decision-making
- Non-invasive therapies
- Pharmacology
- Minimally invasive procedures
- Invasive therapies
- Indwelling catheters
- OAB and benign prostatic hyperplasia
The guideline’s framework for treatment, which is grouped by category, provides an array of therapeutic options making it easier for both clinicians and patients to navigate the decision-making process. We also included a detailed OAB algorithm for clinicians to follow when developing a diagnosis and treatment plan.
Key Guideline Enhancements
Previous versions published in 2012, 2014, and 2019 focused on a stepwise progression of treatments, moving from those that are least invasive to more invasive depending on the patient’s response to each therapy. The 2024 clinical practice guideline emphasizes the broad range of treatments available for overactive bladder to best manage symptoms and improve quality of life.
The wide range of treatment approaches available include behavioral therapies, bladder training, medications, botulinum toxin injections, nerve treatments such as percutaneous tibial nerve stimulation, and sacral neuromodulation. The guideline recognizes that different treatment options may be best suited for different patients depending on factors including side effect profiles, the patient’s ability to adhere to treatment, and insurance coverage, to name a few.
The 2024 guideline also has been updated to include the impact of non-urological contributing factors, such as medical comorbidity, obesity, constipation, and pelvic floor dysfunction, and incorporates recommendations for pharmacotherapy with further discussion of appropriate use.
Not every treatment for OAB is the best option for every single patient, but there is a treatment option for every patient. Ultimately, the guideline stresses the importance of shared decision‐making between the patient and physician to identify the therapy that best meets the patient’s individual circumstances, clinical needs, and preferences.
