6.1: Introduction

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The mainstay of treatment for Overactive Bladder is fluid management, bladder retraining and anticholinergic drug therapy. There are, however, a subset of women who do not respond to these standard treatment regimens and remain incontinent, their symptoms having a profound impact on their quality of life. Studies have shown that only 18% of women stay on their drug treatment for longer than 6 months. This appears to be as a result of inadequate efficacy and not side effects. Morris et al performed one of the only trials on long –term outcomes of women treated for OAB with a standard care package of anticholnergics and bladder retraining. Looking at the same subjects a mean of eight years following discharge from the incontinence clinic, only 7% of the cohort reported being cured, with 65% still suffering significant symptoms. Previously, the only therapeutic option for these patients was surgery in the form of bladder augmentation. These operations, however, carry a high morbidity with most having voiding dysfunction requiring clean intermittent self catheterization, and troublesome mucus production. A number of newer promising treatment options have been developed, including Botulinum Toxin and nerve stimulation techniques.