Management of refractory overactive bladder

Overactive bladder has significant impact on a patient's quality of life. Conservative and pharmacologic management are effective in most patients. Whereas treatment options were limited many years ago for patients who failed first-line therapy, there are now multiple minimally invasive options for them. Detrusor injection of botulinum toxin, which is not yet officially approved for the treatment of idiopathic overactive bladder, significantly improves patient's symptoms and quality of life, and is well tolerated. Two types of neuromodulation are also available: posterior tibial nerve stimulation and sacral nerve stimulation. Promising new medications are in the pipeline. For those who do not respond to the minimally invasive options, augmentation cystoplasty or urinary diversion remain options.