Future directions in overactive bladder treatment: Personalized medicine can be applied?

The treatment of overactive bladder (OAB) is usually started with behavioral treatments [1]. If behavioral treatments are not effective or are only partially effective, oral antimuscarinics or oral β3-adrenoceptor agonists can be offered as a second-line therapy. If symptom control is inadequate or intolerable adverse events are encountered, a dose modification or switching to another antimuscarinic medication or other β3-adrenoceptor agonist can be tried. As a third-line therapy, intradetrusor injection of onabotulinumtoxinA or peripheral tibial nerve stimulation may be of fered in carefully selected patients. Sacral neuromodulation (SNS) is another option for third-line therapy in patients with severe, refractory OAB symptoms who are ready to undergo surgical treatment. Currently, pharmacotherapy is a mainstay of treatment, but one study reported a high rate of non-persistence after the first prescription (44.5%; defined as a gap of >45 days between successive prescription fills or a switch to any other OAB medication) [2], meaning that treatment had been performed insufficiently. The precise pathogenesis of OAB might be multifactorial and remains to be clarified, and OAB symptoms are various. Individuals differ in their sensitivity to drug treatment for a combination of pharmacodynamic and pharmacokinetic reasons. In clinical practice, drug selection should be Future directions in overactive bladder treatment: Personalized medicine can be applied?