Review – Female Urology - Incontinence Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment? Tom Marcelissen a,b , Jean-Nicolas Cornu a,c , Tiago Antunes-Lopes a,d,e , Bogdan Geavlete a,f , Nicolas Barry Delongchamps a,g , Tina Rashid a,h , Malte Rieken a,i , Mohammd Sajjad Rahnama’i a,j,k, * a European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; b Maastricht University Medical Centre, Maastricht, The Netherlands; c Service d’urologie, CHU de Rouen, Rouen, France; d Faculty of Medicine of Porto University, Centro Hospitalar São João, Porto, Portugal; e Department of Urology, Centro Hospitalar São João, Porto, Portugal; f Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania; g Department of Urology, Université Paris Descartes, Hôpital Cochin, Service d’Urologie, Paris, France; h Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; i Department of Urology, Medical University of Vienna, Vienna, Austria; j Maastricht University, Maastricht, The Netherlands; k Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany 1. Introduction Overactive bladder syndrome (OAB) is a prevalent disorder with a major impact on quality of life. It is estimated that OAB affects approximately 11–16% of the adult population, and its prevalence increases with age [1,2]. The aetiology of OAB is probably multifactorial, including changes in anat- omy and body composition, lifestyle factors, and comorbid- ities. Initial management consists of behavioural therapy. This includes bladder training, pelvic floor muscle training, E U R O P E A N U R O L O G Y F O C U S X X X ( 2 0 18 ) X X X – X X X ava ilable at www.sciencedirect.com journa l homepage: www.europea nurology.com/eufocus Article info Article history: Accepted May 11, 2018 Associate Editor: Christian Gratzke Keywords: Overactive bladder syndrome Refractory Detrusor overactivity Drug resistant Abstract Context: A considerable number of patients affected by the overactive bladder syn- drome (OAB) do not respond to pharmacotherapy and bladder training due to unsatis- factory response or intolerability. Objective: To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. Evidence acquisition: PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. Evidence synthesis: Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. Conclusions: None of the mentionedtherapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. Patient summary: In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Maastricht University, Maastricht, The Netherlands. E-mail address: Sajjad_r@yahoo.com (M.S. Rahnama’i). EUF-505; No. of Pages 8 Please cite this article in press as: Marcelissen T, et al. Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment?. Eur Urol Focus (2018), https://doi.org/10.1016/j.euf.2018.05.004 https://doi.org/10.1016/j.euf.2018.05.004 2405-4569/© 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.