• Document: SUFU guideline.
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Diagnosis and treatment of overactive bladder (non- neurogenic) in adults: AUA/SUFU guideline. RECOMMENDATIONS Recommendation 1 - Diagnosis Conditional: The clinician should engage in a diagnostic process to document symptoms and signs that characterize OAB and exclude other disorders that could be the cause of the patient’s symptoms; the minimum requirements for this process are a careful history, physical exam and urinalysis. {Rec_1:Cond_ 1} Recommendation 2 - Diagnosis Conditional: In some patients, additional procedures and measures may be necessary to validate an OAB diagnosis, exclude other disorders and fully inform the treatment plan. At the clinician’s discretion, a urine culture and/or post-void residual assessment may be performed and information from bladder diaries and/or symptom questionnaires may be obtained. {Rec_1:Cond_ 1} Recommendation 3 - Diagnosis Conditional: Urodynamics, cystoscopy and diagnostic renal and bladder ultrasound should not be used in the initial workup of the uncomplicated patient. {Rec_2:Cond_ 2} Recommendation 4 - Treatment Conditional: OAB is not a disease; it is a symptom complex that generally is not a life threatening condition. After assessment has been performed to exclude conditions requiring treatment and counseling, no treatment is an acceptable choice made by some patients and caregivers. {Rec_3:Cond_ 3} Recommendation 5 - Treatment Conditional: Clinicians should provide education to patients regarding normal lower urinary tract function, what is known about OAB, the benefits vs. risks/burdens of the available treatment alternatives and the fact that acceptable symptom control may require trials of multiple therapeutic options before it is achieved. {Rec_4:Cond_ 4} Recommendation 6 - First Line Treatments: Behavioral Therapies Conditional: Clinicians should offer behavioral therapies (e.g., bladder training, bladder control strategies, pelvic floor muscle training, fluid management) as first line therapy to all patients with OAB. {Rec_5:Cond_ 5} Recommendation 7 - First Line Treatments: Behavioral Therapies Conditional: Behavioral therapies may be combined with anti-muscarinic therapies. {Rec_6:Cond_ 6} Recommendation 8 - Second-Line Treatments: Anti-Muscarinics Conditional: Clinicians should offer oral anti-muscarinics, including darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine or trospium (listed in alphabetical order; no hierarchy is implied) as second-line therapy. {Rec_8:Cond_ 8} Recommendation 9 - Second-Line Treatments: Anti-Muscarinics Conditional: If an immediate release (IR) and an extended release (ER) formulation are available, then ER formulations should preferentially be prescribed over IR formulations because of lower rates of dry mouth. {Rec_7:Cond_ 7} Recommendation 10 - Second-Line Treatments: Anti-Muscarinics Conditional: Transdermal (TDS) oxybutynin (patch or gel) may be offered. {Rec_9:Cond_ 9} Recommendation 11 - Second-Line Treatments: Anti-Muscarinics Conditional: If a patient experiences inadequate symptom control and/or unacceptable adverse drug events with one anti-muscarinic medication, then a dose modification or a different anti- muscarinic medication may be tried. {Rec_10:Cond_ 10} Recommendation 12 - Second-Line Treatments: Anti-Muscarinics Conditional: Clinicians should not use anti-muscarinics in patients with narrow angle glaucoma unless approved by the treating ophthalmologist and should use anti-muscarinics with extreme caution in patients with impaired gastric emptying or a history of urinary retention. {Rec_11:Cond_ 11} Conditional: Clinicians should not use anti-muscarinics in patients with narrow angle glaucoma unless approved by the treating ophthalmologist and should use anti-muscarinics with extreme caution in patients with impaired

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