Overactive Bladder/Urge Incontinence · Stepped Therapy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Conservative/medical response
   Adequate conservative therapy? Medication effective/tolerated?
   • Newly diagnosed/not adequately treated conservatively → First-line → behavioral therapy
   • Conservative failure → Second-line → medication
   • Medication ineffective/intolerant (refractory) → Third-line → SNM/PTNS/botulinum toxin
2. [End] First-line → behavioral therapy
   First-line behavioral therapy: bladder training, pelvic floor muscle training, fluid/caffeine management, weight loss; advance to second-line if ineffective.
3. [End] Second-line → medication
   Second-line medication: anticholinergic or beta-3 agonist (mirabegron/vibegron); use anticholinergics cautiously in the elderly (cognition/anticholinergic burden); advance to third-line if ineffective/intolerant.
4. [End] Third-line → SNM/PTNS/botulinum toxin
   Third-line (refractory): sacral neuromodulation (SNM), percutaneous tibial nerve stimulation (PTNS), or intravesical onabotulinumtoxinA injection (idiopathic 100 U; check post-void residual before and after to prevent retention); choose among the three by preference and suitability.

Source guidelines & references

• Idiopathic overactive bladder (AUA/SUFU 2024 guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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