OVERACTIVE BLADDER (U LEE AND S ADELSTEIN, SECTION EDITORS) Contemporary Landmark Trials Update in the Management of Idiopathic Overactive Bladder Emily C. Rutledge 1 & Natalia Hernandez 2 & Ricardo R. Gonzalez 2 Accepted: 23 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose of Review The landmark trials evaluating the different lines of treatment for overactive bladder (OAB) were reviewed to provide a summary of the most recent advances in behavioral, medical, and surgical management of OAB in the last 5 to 10 years. Recent Findings Clinical trials for the treatment of OAB have evaluated the efficacy and effectiveness of different combinations of medical management, surgical management, and conservative therapies in quality of life improvement in these patients. All three lines of therapy include safe and effective treatment options that can be used as monotherapy or in combination to treat a variety of patient characteristics and comorbidities. Summary The three lines of treatment currently available to patients continue to be improved with new innovations in strategies for their use in combination with one another and improving technology to make them safer, more effective, and individualized to each patient’s needs. Keywords Idiopathic overactive bladder . Urge urinary incontinence . Narrative review . Landmark trials Introduction Overactive bladder (OAB) is a common genitourinary condi- tion that is defined as bothersome urinary urgency (with or without incontinence), frequency, and nocturia in the absence of underlying infection or other pathologic processes. Among its associated comorbidities, OAB causes a reduction in qual- ity of life and causes an economic burden to both the patient and society [1]. This review will focus on idiopathic OAB. OAB occurs more frequently in women than men and has an increasing prevalence with age. It affects over 45% of women ages 65 and older [2, 3]. Other risk factors include post- menopausal status, prior pelvic surgery, frailty, and obesity [4]. OAB carries not only a physical and mental toll by leading to social isolation and diminishing quality of life but also carries a financial burden [3]. It is estimated that the cost to patients and society is on the order of billions and increases every year with a growing older population in the USA [1]. OAB is clinically diagnosed but more in-depth evaluation or procedures may be required to rule out underlying pathol- ogy. Urinalysis and urine culture can be used to assess for infection. Post void residual (PVR) is used to assess bladder emptying. For an uncomplicated OAB patient, urodynamic testing, cystoscopy, or other imaging are not typically war- ranted but may be considered treatment progresses [5]. The terminology used in the diagnosis of OAB varies and can make it difficult to interpret findings across studies. The definition used in this review includes urgency, frequency, nocturia, and urge incontinence encompassing all of the symp- toms included under the diagnostic umbrella of OAB [5]. Another area that deserves attention is the diagnosis of geni- tourinary syndrome of menopause (GSM). Previously, the description of a hypoestrogenic state leading to a constellation of genital, urinary, and sexual symptoms was described under various names, including vulvovaginal atrophy, atrophic vag- initis, or urogenital atrophy [6]. While these diagnoses This article is part of the Topical Collection on Overactive Bladder * Emily C. Rutledge ecrutledge@houstonmethodist.org Natalia Hernandez nhernandez2@houstonmethodist.org Ricardo R. Gonzalez RRGonzalez@houstonmethodist.org 1 Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin St. Suite 901, Houston, TX 77030, USA 2 Department of Urology, Houston Methodist Hospital, Houston, TX, USA Current Bladder Dysfunction Reports https://doi.org/10.1007/s11884-020-00617-w