American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline - Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults

Sep 7, 2026

Provides a clinical framework for diagnosing and treating non-neurogenic overactive bladder (OAB) in adults, specifying evidence-based guideline statements. Diagnosis emphasizes documenting characteristic symptoms and signs, using history, physical exam, and urinalysis, and selectively adding urine culture, post-void residual assessment, bladder diaries, or questionnaires. Initial workups should not include urodynamics, cystoscopy, or diagnostic renal/bladder ultrasound for uncomplicated cases. Treatment recommends first-line behavioral therapies, possible combination with pharmacologic management, then second-line oral agents (anti-muscarinics or β3-adrenoceptor agonists) with formulation preferences and stepwise adjustments based on response and adverse events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages50

Reading Time2 h 6 min

AccessFree to download

Guideline Purpose and Methods

Guideline Statements

Diagnosis

Treatment

First-Line Treatments: Behavioral Therapies

Second-Line Treatments: Pharmacologic Management

Approved by the AUABoard of Directors April 2019 Authors’ disclosure of potential conflicts of interest and author/staff contributions appear atthe end of the article. © 2019 by the American Urological Association The Panel would like to acknowledge Martha M. Faraday, Ph.D., for her methodological expertise and invaluable contributions as well asthe Vanderbilt Evidencebased Practice Center for the preparation of the evidence report commissioned by the Agency for Healthcare Research and Quality (AHRQ). The Practice Guidelines Committee would like to acknowledge the contributions of Dr. Alexander Gomelsky to the 2019 Guideline Amendment . 1 American Urological Association (AUA)/ Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER (Non-Neurogenic) IN ADULTS: AUA/SUFU GUIDELINE E. Ann Gormley, Deborah J. Lightner, Kathryn L. Burgio, Toby C. Chai, J. Quentin Clemens, Daniel J. Culkin, Anurag Kumar Das, Harris Emilio Foster, Jr., Harriette Miles Scarpero, Christopher D. Tessier, Sandip Prasan Vasavada Purpose: The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder (OAB) . Methods: The primary source of evidence for the original version of this guideline was the systematic review and data extraction conducted as part of the Agency for Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assessment Number 187 titled Treatment of Overactive Bladder in Women (2009).1 That report searched PubMed, MEDLINE, EMBASE, and CINAHL for English-language studies published from January 1966 to October 2008 relevant to OAB. AUA conducted additional literature searches to capture treatments not covered in detail by the AHRQ report (e.g., intravesical onabotulinumtoxinA) and relevant articles published between October 2008 and December 2011. The review yielded an evidence base of 151 treatment articles after application of inclusion/ exclusion criteria. These publications were used to create the majority of the treatment portion of the guideline. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) . Additional treatment information is provided as Clinical Principles and Expert Opinions when insufficient evidence existed. Following initial publication, this Guideline underwent amendment in 2014 and 2019 to pull in literature released since the initial publication of the Guideline. The current document reflects relevant literature published through October 2018. See text and algorithm for definitions and detailed diagnostic, management and treatment frameworks. Guideline Statements Diagnosis: 1. 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. Clinical Principle 2. 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. Clinical Principle 3. Urodynamics, cystoscopy and diagnostic renal and bladder ultrasound should not be used in the initial workup of the uncomplicated patient. Clinical Principle 4. OAB is not a disease; it is a symptom complex that generally is not a lifethreatening 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. Expert Opinion 5. Clinicians should provide education to patients regarding

FAQs

What is the minimum diagnostic process recommended for non-neurogenic overactive bladder?

A careful history, physical exam, and urinalysis are the minimum requirements to document OAB-relevant symptoms and signs and to exclude other causes.

Which tests should not be used in the initial workup for an uncomplicated patient with OAB?

Urodynamics, cystoscopy, and diagnostic renal and bladder ultrasound should not be used in the initial evaluation of uncomplicated cases.

What are the recommended first-line and second-line treatments for OAB?

First-line treatments are behavioral therapies such as bladder training, bladder control strategies, pelvic floor muscle training, and fluid management. Second-line therapy includes oral anti-muscarinics or oral β3-adrenoceptor agonists, with further adjustments based on symptom control and adverse events.

Sep 7, 2026

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