Overactive bladder (OAB) is a symptom complex that includes urinary urgency, frequency, urgency incontinence, and nocturia. It is highly prevalent, affecting up to 12% of the adult population, and can significantly impact quality of life. The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies. The need for additional testing is based on the initial evaluation findings, and is recommended in cases of underlying urinary tract infection, microscopic hematuria, obstructive voiding symptoms, and symptoms refractory to previous treatments. Initial management includes behavioral modification with attention to total daily fluid intake, avoidance of bladder irritants, treatment of constipation, weight loss, timed voiding, urge-suppression techniques, and pelvic floor physical therapy. Options for oral medications include antimuscarinic agents and β adrenergic agents, and can be used following or in conjunction with behavioral treatment. For patients refractory to behavioral therapy and oral medications, consideration should be given to referral to a specialist (eg, a urologist or urogynecologist) for discussion of more advanced therapies such as sacral neuromodulation, percutaneous tibial nerve stimulation, and intradetrusor injection of onabotulinumtoxinA. These more advanced treatments have favorable efficacy compared with oral agents in randomized trials, although each has a unique risk/benefit profile and shared decision-making with the individual patient is crucial. Here, we review pertinent considerations in the clinical evaluation and management of OAB in women.

中文翻译：

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女性膀胱过度活动症的评估和治疗。

膀胱过度活动症（OAB）是一种症状复合体，包括尿急，尿频，尿失禁和夜尿症。它非常普遍，影响了多达12％的成年人口，并且可以显着影响生活质量。OAB的诊断通过病史，体格检查和尿液分析来排除潜在的感染或其他与潜在病因有关的疾病。根据最初的评估结果，需要进行其他检查，并建议用于潜在的尿路感染，镜下血尿，阻塞性排尿症状以及以前的治疗方法难以治愈的症状。最初的管理包括注意行为改变，注意每日总液体摄入量，避免膀胱刺激物，便秘的治疗，体重减轻，定时排尿，催促抑制技术，和骨盆底物理治疗。口服药物的选择包括抗毒蕈碱药和β肾上腺素药，可在行为治疗后或与行为治疗结合使用。对于不能接受行为疗法和口服药物治疗的患者，应考虑转介专家（例如泌尿科医师或泌尿妇科医师）来讨论更先进的治疗方法，例如神经调节，经皮胫骨神经刺激和intotrutrusor注射载脂蛋白A。在随机试验中，与口服药物相比，这些更先进的治疗方法具有良好的疗效，尽管每种药物都有独特的风险/获益特征，与每个患者的共同决策至关重要。在这里，我们回顾了女性OAB的临床评估和管理中的相关考虑因素。口服药物的选择包括抗毒蕈碱药和β肾上腺素药，可在行为治疗后或与行为治疗结合使用。对于不能接受行为疗法和口服药物治疗的患者，应考虑转介专科医生（例如泌尿科医师或泌尿妇科医师）来讨论更高级的疗法，例如神经调节，经皮胫骨神经刺激和intotrutrusor注射肉毒杆菌毒素A。在随机试验中，与口服药物相比，这些更先进的治疗方法具有良好的疗效，尽管每种药物都有独特的风险/获益特征，与每个患者的共同决策至关重要。在这里，我们回顾了女性OAB的临床评估和管理中的相关考虑因素。口服药物的选择包括抗毒蕈碱药和β肾上腺素药，可在行为治疗后或与行为治疗结合使用。对于不能接受行为疗法和口服药物治疗的患者，应考虑转介专科医生（例如泌尿科医师或泌尿妇科医师）来讨论更高级的疗法，例如神经调节，经皮胫骨神经刺激和intotrutrusor注射肉毒杆菌毒素A。在随机试验中，与口服药物相比，这些更先进的治疗方法具有良好的疗效，尽管每种药物都有独特的风险/获益特征，与每个患者的共同决策至关重要。在这里，我们回顾了女性OAB的临床评估和管理中的相关考虑因素。