Salvage Combination Therapies for Refractory Overactive Bladder

Abstract

With a high prevalence of overactive bladder (OAB) worldwide and rising health care costs for patients who fail first-, second-, and third-line treatments, there is a growing need to explore novel strategies to address the most refractory cases of OAB. The concept of utilizing combination treatment regimens to maximize efficacy while minimizing morbidity and side effects, in a cost-effective manner, is discussed in this review article. A literature review over the last 10 years was performed, focusing on therapies used in combination for OAB including behavioral therapy, pharmacologic therapy, neuromodulation, and botulinum toxin. A separate literature review specifically for augmentation cystoplasty was also undertaken. Such “salvage” treatments suggested in the literature include pharmacologic therapy in combination or with behavioral modification, various forms of neuromodulation with medication, alternative forms of neuromodulation, with or without prior botulinum toxin injections, and lastly, augmentation cystoplasty. In this review article, we outline combination therapies such as adding mirabegron to solifenacin, anticholinergic medication in addition to either behavioral therapy or various types of neuromodulation and using neuromodulation after failed botulinum toxin injections are efficacious treatment approaches and have shown to be superior to monotherapy for the treatment non-neurogenic refractory OAB. In the most severe cases of refractory OAB, augmentation cystoplasty remains an option that provides acceptable results in the appropriately selected patient.