What Treatment Should We Use If Drugs Fail for OAB; and, What Really Works After Drugs?

Aims: To determine (using structured brain storm sessions), which treatments should be used if drugs fail for OAB and to determine priority research questions in relation to this issue. Methods: A frame work for discussion was prepared by the chairman of the session; this included a brief summary of the currently existing evidence. Several experts had been asked to prepare a presention of their personal treatment algorithm and to identify the [lack of] evidence for such an algorithm. These presentations were summarized by the chairman. Next, this summary was discussed with a large group of experts and opinion leaders and audio-recorded. The proceedings of this process are the basis for this manuscript. Results: The structured sessions resulted in detailed statements about: possible reasons for failure of conservative treatment:, the evaluation of outcomes of RCT's, the use of botulinum toxin A in refractory OAB patients, the relative place of neuromodulation or sacral nerve stimulation and botulinum toxin A in the treatment of refractory OAB. Conclusions: A list of 10 unanswered questions and research topics was compiled. Additionally, 5 top priority research topics were identified.