Phenotyping Overactive Bladder - Part 2: Can Management be Improved by Phenotyping, and Targeting Therapy According to Urgency Type and Other Characteristics? ICI-RS 2025

INTRODUCTION: Management of overactive bladder (OAB) has a stepwise approach in adults and children. This does not account for individual patient variations, which may explain suboptimal outcomes in many patients. Distinct OAB profiles, based on patient characteristics, symptoms, urodynamic findings and imaging have been discussed in Part 1. Personalized treatment and escalation pathways based on OAB profiling may lead to faster OAB symptom control and quality of life improvement, reduced cumulative side effects and costs, and improved treatment adherence.

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, and targeting therapy according to urgency type and other characteristics?" The group discussed the current literature on this topic and developed a list of research questions and strategies to help shape the future of the field.

RESULTS: Tailored combination of antimuscarinics and/or beta3 agonists, with botulinum toxin A (BTX-A) and/or sacral nerve stimulation (SNS) was considered a high priority research topic. Profile-based individual treatment selection and delivery protocols for BTX-A and SNS are potential means to improve outcomes, as is the early escalation to BTX-A and SNS in the treatment pathway of both adults and children. Finally, phenotype-based treatment requires tight treatment outcome follow-up and possible adjustment (including re-phenotyping) for which tools need to be developed.

CONCLUSION: Development and validation of a patient-based flow-chart to replace the current stepwise approach in OAB management will allow tailored treatment, aimed to improve therapeutic success, and to reduce side effects.