Overactive bladder (OAB) is common among women, increases in prevalence with age, and exerts a considerable physical, psychological and socioeconomic burden. This narrative review discusses issues specific to the management of OAB in women.
The review is based on discussions at a symposium held at the International Urogynecological Association/European Urogynaecological Association meeting (Barcelona, Spain; June 2025) supplemented by a PubMed search of articles (published in English since 1 January 2020) describing current treatment practices, unmet clinical needs and future directions for the management of OAB in women.
The pathophysiology of OAB in women is multifactorial, involving detrusor overactivity, urothelial and sensory dysfunction, and central nervous system dysregulation, with additional contributions from hormonal and age-related changes. Management of OAB has evolved toward an individualised, stepwise approach. Behavioural and lifestyle interventions remain first-line therapy, followed by pharmacological options, such as antimuscarinics and β3-adrenergic agonists. For refractory cases, onabotulinumtoxin A and neuromodulation are established third-line treatments. Local oestrogen therapy or prasterone may provide benefit in selected postmenopausal women, whereas radiofrequency and urethral bulking strategies remain investigational. Emerging evidence supports newer β3-agonists, such as vibegron, which may provide comparable efficacy to established β3-agonists (e.g. mirabegron) with improved cardiovascular tolerability. Treatment selection for women with OAB should consider comorbidities, drug safety, cognitive and cardiovascular risk in older patients, and challenges with adherence.
Further research into underlying mechanisms, long-term outcomes and strategies to optimise treatment adherence will be essential to improve symptom control and quality of life for women living with OAB.
World journal of urology. 2026 Jun 01*** epublish ***
Andrea Braga, Howard B Goldman, Anna Padoa, Maurizio Serati
Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale - Beata Vergine Hospital, Mendrisio, Switzerland., Glickman Urologic Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH, 44195, USA. ., Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel., Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.