Phenotyping Overactive Bladder-Part 1: Are There Different Types of Urgency and Can They be Translated to Clinical, Urodynamic and Radiological Phenotyping? ICI-RS 2025

INTRODUCTION: Overactive bladder (OAB) is defined as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urgency urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease. The key symptom of OAB, urinary urgency, is defined as a complaint of sudden, compelling desire to pass urine which is difficult to defer. However, patients report a range of individual experiences and sensations associated with urgency and studies have identified different types of urgency. Patients with OAB not only differ in clinical presentation, but also have different urodynamic and radiological findings. These variations may explain why OAB treatments work well for some individuals but not others. This paper investigates how knowledge can be advanced by phenotyping OAB by urgency symptom variation, and clinical, urodynamic measurements and radiological features.

METHODS: A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping if there are different types of urgency?" The group discussed the current literature on this topic and developed a list of research questions to help shape the future of the field.

RESULTS: Clinical, urodynamic and radiological phenotyping of urgency were discussed and research studies to phenotype urgency were proposed.

CONCLUSION: Further research to phenotype OAB beyond the presence or absence of urgency and urgency urinary incontinence, using clinical, urodynamic measurements and radiological features, is needed. High priority research questions and strategies were defined. Advanced OAB phenotyping may guide tailored management beyond a stepwise approach, with the aim to improve therapeutic outcomes. This would validate phenotyping and is explored in Part 2 of the topic.