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AUA Announces Amendments to Overactive Bladder, Clinical Practice Guideline

Linthicum, MD, May 18, 2014 — The American Urological Association (AUA) today announced revisions to its 2012 Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults clinical guideline, jointly released by the AUA and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU). These amendments were made as part of the AUA’s update literature review process, whereby an additional systematic review is conducted to maintain guideline currency with newly published relevant literature.

The Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults guideline was amended as follows:

  • In some statements referencing oral anti-muscarinic therapies, beta-3 adrenoceptor agonists were added as an additional oral therapy (see Guideline Statements 8, 11 and 15).
  • The following “Third Line Treatment” statements were re-ordered and/or evidence level upgraded:
    • Statement 17: Clinicians may offer intradetrusor onabotulinumtoxinA (100U) as third-line treatment in the carefully-selected and thoroughly-counseled patient who has been refractory to first- and second-line OAB treatments.  The patient must be able and willing to return for frequent post-void residual evaluation and able and willing to perform self-catheterization if necessary.  Standard (Evidence Strength Grade B).
    • Statement 18: Clinicians may offer peripheral tibial nerve stimulation (PTNS) as third line treatment in a carefully selected patient population.  Recommendation (Evidence Strength Grade C).
    • Statement 19: Clinicians may offer sacral neuromodulation (SNS) as third line treatment in a carefully selected patient population characterized by severe refractory OAB symptoms or patients who are not candidates for second-line therapy and are willing to undergo a surgical procedure.  Recommendation (Evidence Strength Grade C).
  • In addition to these changes, the following statement was added to the Third Line Treatment section of the document:
    • Statement 20:Practitioners and patients should persist with new treatments for an adequate trial in order to determine whether the therapy is efficacious and tolerable.  Combination therapeutic approaches should be assembled methodically, with the addition of new therapies occurring only when the relative efficacy of the preceding therapy is known.  Therapies that do not demonstrate efficacy after an adequate trial should be ceased. Expert Opinion.

The full version of the amended OAB guideline is available here:

All AUA clinical practice guidance documents, including guidelines, best practices and white papers, are available online at

NOTE TO REPORTERS: Expert spokespeople are available to discuss these Guidelines. Please contact the Communications Office at 410-689-3932 for more information or to arrange an interview.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 20,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.

Christine Frey, AUA