Overactive Bladder & Urgency Incontinence (OAB/UUI)
OAB is a symptom syndrome, not a structural diagnosis — urinary urgency, usually with frequency and nocturia, with or without urgency incontinence, in the absence of infection or other obvious pathology.
The big picture
OAB is a symptom syndrome, not a structural diagnosis — urinary urgency, usually with frequency and nocturia, with or without urgency incontinence, in the absence of infection or other obvious pathology. Because it's symptom-defined, the workup is deliberately minimal and the treatment is a stepwise ladder — start conservative, escalate only as needed. Knowing the ladder (and what NOT to do up front) is the whole game.
The framework: define OAB → minimal evaluation (no routine invasive tests) → behavioural first → pharmacotherapy (beta-3 / antimuscarinic) → minimally invasive third-line (botulinum, SNM, PTNS).
Mechanism pathway
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Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
OAB is symptom-defined: urgency ± frequency/nocturia ± UUI, no UTI/other cause.
Don't routinely do urodynamics, cystoscopy, or imaging up front — only in complicated cases.
Behavioural therapy is first-line for everyone.
Second-line = beta-3 (mirabegron/vibegron) OR antimuscarinic; prefer beta-3 in older adults (anticholinergic cognitive/dementia risk).
Third-line = botulinum toxin (100 U), SNM, or PTNS — BoNT-A risks retention/CIC.
Avoid indwelling catheters for OAB.
Topical (vaginal) oestrogen helps OAB symptoms and recurrent UTIs in postmenopausal GSM — it's local, not systemic (systemic oestrogen can worsen incontinence).