The Overactive Bladder and the AUA Guidelines: A Proposed Clinical Pathway for Evaluation and Effective Management in a Contemporary Urology Practice

Introduction The 2014 American Urological Association Overactive Bladder Guidelines provide for the evaluation and effective treatment of patients with overactive bladder by all providers. Once the evaluation rules out other causes of these symptoms, the primary treatment of overactive bladder is behavioral. Changing bladder behavior is associated with a high degree of symptom improvement and is successful in most whereas cure remains elusive. Patient treatment outcomes will likely be inadequate if the patient remains uninformed about achievable bladder behavior, if shared and realistic goals of treatment are not established, and if the patient does not actively participate in modifying his/her bladder behavior. Methods The senior authors of the AUA Overactive Bladder Guidelines from 2 major medical centers, specializing in lower urinary tract symptoms, present a unified clinical strategy for the busy outpatient clinic. A single visit rapidly evaluates and stratifies the management options for those with overactive bladder, establishing realistic treatment goals. Results Patient evaluation, management and outcomes are remarkably similar between 2 independently developed practices, both centered on achieving patient education and clinical efficiency. Conclusions An algorithmic approach to the evaluation and management of overactive bladder based on the AUA guidelines emphasizes education, the setting of realistic and shared goals for management, and enhancing self-care. Evaluation and behavioral management can be efficiently started within a single visit, reducing pressure on the urologist to provide ultimately unhelpful or even harmful therapies.