How to Define a Refractory Idiopathic Overactive Bladder?

AimsTo present the different definitions of refractory IOAB. Materials and MethodsA review of the literature based on PubMed and Cochrane library databases has been conducted. The criteria for defining the success or failure of antimuscarinic treatment and the different definitions of refractory IOAB used in studies evaluating the effects of posterior tibial nerve stimulation, sacral neuromodulation and intradetrusor botulinum toxin-A injections, have been presented. The primary endpoints of these studies were compared. Additionally, different definitions of refractory IOAB were retrieved. ResultsThere are discrepancies in the definition of refractory IOAB in the literature. The definitions of antimuscarinic success in clinical trials are not always transposable into daily practice. Moreover, these clinical trial endpoints do not explore the entirety of a meaningful patient-centered outcome. The failure of antimuscarinic treatments may be defined by different factors, including lack and loss of efficacy, intolerance to side effects, contraindications, willingness of patients to go further with treatment and inadequacy of patient's expectations. Ideally, the best functional outcomes would assess patient's expectations and the physician's objectives and objective measurements. Finally, assessing quality of life might be the most reliable outcome to measure, by considering of all the discussed data. ConclusionsAn appropriate definition is complex and needs to consider subjective tools. The refractory IOAB needs to be more specifically defined so that alternative treatments can be used at the appropriate time. Neurourol. Urodynam. 34:2-11, 2015. (c) 2013 Wiley Periodicals, Inc.