Navigating the challenges of overactive bladder management in women
World J Urol · 2026 · Switzerland
Source and licence
- Authors
- Andrea Braga, Howard B. Goldman, Anna Padoa et al.
- Title
- Navigating the challenges of overactive bladder management in women
- Journal
- World Journal of Urology, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13226424
Licence statement of the original publication
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Abstract
Purpose: Overactive bladder (OAB) is common among women, increases in prevalence with age, and exerts a considerable physical, psychological and socioeconomic burden. This narrative review discusses issues specific to the management of OAB in women.
Methods: The review is based on discussions at a symposium held at the International Urogynecological Association/European Urogynaecological Association meeting (Barcelona, Spain; June 2025) supplemented by a PubMed search of articles (published in English since 1 January 2020) describing current treatment practices, unmet clinical needs and future directions for the management of OAB in women.
Results: The pathophysiology of OAB in women is multifactorial, involving detrusor overactivity, urothelial and sensory dysfunction, and central nervous system dysregulation, with additional contributions from hormonal and age-related changes. Management of OAB has evolved toward an individualised, stepwise approach. Behavioural and lifestyle interventions remain first-line therapy, followed by pharmacological options, such as antimuscarinics and β3-adrenergic agonists. For refractory cases, onabotulinumtoxin A and neuromodulation are established third-line treatments. Local oestrogen therapy or prasterone may provide benefit in selected postmenopausal women, whereas radiofrequency and urethral bulking strategies remain investigational. Emerging evidence supports newer β3-agonists, such as vibegron, which may provide comparable efficacy to established β3-agonists (e.g. mirabegron) with improved cardiovascular tolerability. Treatment selection for women with OAB should consider comorbidities, drug safety, cognitive and cardiovascular risk in older patients, and challenges with adherence.
Conclusion: Further research into underlying mechanisms, long-term outcomes and strategies to optimise treatment adherence will be essential to improve symptom control and quality of life for women living with OAB.
Contents of the original publication
The section headings of the original.
- Introduction
- Evidence acquisition
- Overactive bladder: pathophysiology in women
- Hormonal and age-related changes in the development of OAB in women
- Current management of OAB in women
- Current challenges of pharmacotherapy for OAB management in women
- Medication adherence and persistence
- Cognitive impairment and dementia
- Falls and fractures
- Cardiovascular considerations
- Mortality risk
- Management of OAB in older women
- Management of OAB in pregnant women
- Future directions for the management of OAB in women
- Vibegron
- Radiofrequency
- Urethral bulking agents
- Conclusions
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