Wat te doen als pillen niet werken bij urge-incontinentie? Nog veel vragen en onduidelijkheden

Bladder training and antimuscarinics are first-line treatments for the symptoms of an overactive bladder. Unfortunately, many patients stop using drugs due to undesirable effects or limited efficacy. The paper by Smits et al. contains a summarisation of various neuromodulation treatments that can be offered to patients after first-line treatments have failed, e.g. sacral neuromodulation, posterior tibial nerve stimulation, pudendal neuromodulation and intravesical botulinum toxin A. An unambiguous treatment algorithm based on RCTs is lacking at this time; however, postulation of a patient’s profile is possible. Research in the field of dysfunctional voiding should focus on comparing the different treatment options in order to create an algorithm based on science.

Conflict of interest: Dr E.L. Koldewijn received remuneration from Allergen B.V., Astellas B.V. and Glaxo Smith Kline B.V. for consultancy services. Financial support for this article: none declared.