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Overactive bladder

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of overactive bladder are prepared by our editorial team based on guidelines from the European Association of Urology (EAU/EAUN 2025), the American Urological Association (AUA/SUFU 2024), the Canadian Urological Association (CUA 2024), the American Physical Therapy Association (APTA 2023), and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2020,2014).
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Diagnostic investigations

History and physical examination: as per EAU/EAUN 2025 guidelines, elicit a complete medical history, including symptoms and comorbidities, and perform a focused physical examination in patients with LUTS.
A
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  • Urine tests

  • Urodynamic studies

  • Post-void residual volume

  • Urinary tract imaging

Diagnostic procedures

Cystoscopy: as per AUA/SUFU 2024 guidelines, do not perform routine cystoscopy in the initial evaluation of patients with overactive bladder. Consider performing cystoscopy in case of diagnostic uncertainty.
D
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Medical management

General principles
As per EAU/EAUN 2025 guidelines:
Identify and address comorbidities associated with overactive bladder, such as obstructive sleep apnea and obesity.
B
Use a shared decision-making process involving both clinicians and patients when selecting the appropriate conservative management or pharmacotherapy for overactive bladder.
A
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  • Anticholinergics and beta-3 agonists (indications)

  • Anticholinergics and beta-3 agonists (management of medication adverse effects)

  • Antibiotic prophylaxis

  • Management of genitourinary syndrome of menopause

  • Management of constipation

  • Management of fall risk

Nonpharmacologic interventions

Lifestyle modifications: as per EAU/EAUN 2025 guidelines, advise reducing caffeine intake to improve symptoms of urgency and frequency but not incontinence in adult patients with overactive bladder.
A
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  • Behavioral therapy

  • Bladder training

  • Pelvic floor muscle training

  • Incontinence pads and devices

  • Alternative and complementary therapies

Therapeutic procedures

General principles
As per AUA/SUFU 2024 guidelines:
Consider offering minimally invasive procedures in patients with overactive bladder unable or unwilling to undergo behavioral, noninvasive, or pharmacologic therapies,
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or without prior trials of these treatments in the context of shared decision-making.
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Discontinue oral medications in patients with overactive bladder having an appropriate response to a minimally invasive procedure, but restart pharmacotherapy again if efficacy is not sustained.
E
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  • Urinary catheterization

  • Intradetrusor onabotulinumtoxin A

  • Tibial nerve stimulation

  • Sacral nerve stimulation

  • Vaginal electrical stimulation

  • Vaginal laser therapy

Surgical interventions

Augmentation cystoplasty
As per EAU/EAUN 2025 guidelines:
Offer augmentation cystoplasty in patients with overactive bladder/urgency urinary incontinence not responding to all other treatment options and after informing about all possible complications.
B
Inform patients undergoing augmentation cystoplasty of the high risk of clean intermittent catheterization (ensure they are willing and able to do so) and that they will need life-long surveillance.
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  • Urinary diversion

  • Detrusor myectomy

Specific circumstances

Patients with BPH
As per AUA/SUFU 2024 guidelines:
Consider offering initial management with noninvasive therapies, pharmacotherapy, or minimally invasive therapies in patients with BPH and bothersome overactive bladder, in the context of shared decision-making.
E
Offer monotherapy with antimuscarinic agents or β-3 agonists, or combination therapy with an α-blocker and an antimuscarinic agent or β-3 agonist in patients with BPH and overactive bladder.
B
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  • Patients with postoperative overactive bladder

Patient education

General counseling
As per EAU/EAUN 2025 guidelines:
Inform female patients with overactive bladder and/or their carers regarding available treatment options before deciding on urinary containment alone.
A
Provide counseling and life-long support both before and after major surgery for overactive bladder.
A
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Follow-up and surveillance

Follow-up: as per EAU/EAUN 2025 guidelines, obtain cystoscopic surveillance in female patients after augmentation cystoplasty because of the small risk of malignancy.
B
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