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How to cite: Badlani GH. Refractory OAB: How Do I Manage? Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/refractory-oab-how-do-i-manage/
Summary
Gopal H. Badlani, MD, FACS, FRCS, Co-Director, Urology Department, Wake Forest University, Winston-Salem, North Carolina, reviews advanced therapeutic options for patients with refractory overactive bladder (OAB). Dr. Badlani focuses on actionable clinical workflows, decision-making factors, coding considerations, and procedural preferences. He discusses everyday urologic practice, offering a clear sense of how to evaluate patients, select appropriate interventions, and manage both short and long-term therapeutic needs.
Dr. Badlani begins with initial evaluation strategies, emphasizing questionnaires, urinalysis, post-void residual measurement, and targeted history-taking. He outlines exam components, including mobility, cognition, and manual dexterity. Baseline laboratory tests help determine whether comorbidities may influence treatment choice or risk.
Dr. Badlani discusses how the standard first visit offers options including bladder training, medication trial, or scheduling urodynamics. For those moving to procedural therapy, he discusses botulinum toxin injection steps, including urinalysis (UA) and culture, infection clearance, Clean Intermittent Catheterization (CIC) teaching when necessary, and the practical considerations of scopes, needles, and injection techniques. He explains site selection differences between supratrigonal, submucosal, and detrusor approaches.
Sacral neuromodulation is outlined in detail. Dr. Badlani describes his preference for a two-stage protocol, unilateral lead placement based on the best response, and the expectation of a one- to two-week trial with a target of 50% symptom improvement. He notes practical considerations between device systems and emphasizes clinical experience as a factor.
Dr. Badlani emphasizes key practice principles, highlighting that time investment, staff support, personal bias, and patient goals all shape treatment success.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
For further educational activities from this conference, visit our collection page.
