Invasive procedures for overactive bladder in women

Invasive procedures for overactive bladder in women

Management is undertaken via a specialist team.

Options include:

• augmentation cystoplasty restricted for the management of idiopathic detrusor overactivity to women whose condition has not responded to non-surgical management and who are willing and able to self-catheterise
  
  
• bladder wall injection with botulinum toxin type A1 to women with OAB caused by detrusor overactivity that has not responded to non-surgical management, including pharmacological treatments
  • risk of adverse effects, including an increased risk of urinary tract infection
  • start treatment only if the woman is willing, in the event of developing significant voiding dysfunction: to perform clean intermittent catheterisation on a regular basis for as long as needed or to accept a temporary indwelling catheter if she is unable to perform clean intermittent catheterisation.
    
    
• percutaneous posterior tibial nerve stimulation
  • non-surgical management including OAB medicine treatment has not worked adequately and the woman does not want botulinum toxin type A1 or percutaneous sacral nerve stimulation
    
    
• percutaneous sacral nerve stimulation
  
  
• urinary diversion
  • considered for a woman with OAB only when non-surgical management has failed, and if botulinum toxin A1, percutaneous sacral nerve stimulation and augmentation cystoplasty are not appropriate or are unacceptable to her

Reference:

• NICE (April 2019). Urinary incontinence and pelvic organ prolapse in women: management