Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.
This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.
Cystoscopy, urodynamics or diagnostic renal and bladder ultrasound should not be performed in the initial work-up of a patient with an uncomplicated overactive bladder (OAB).
However, renal tract ultrasound may be required to help confirm the OAB is uncomplicated. This advice applies only when carcinoma in situ (CIS) is considered unlikely and when midstream urine tests (microscopy, culture and sensitivity; and cytology) are normal.
When is the procedure indicated?
OAB can be a symptom of CIS, bladder cancer, bladder stones or stricture. If there is a need to exclude other causes for symptoms, such as cancer, a cystoscopy may be considered.
Best care recommendations
Diagnosis should be made by documenting symptoms and signs that characterise OAB and by excluding other disorders that could be the cause of the patient’s symptoms through careful history taking, physical examination and urinalysis.
In some patients, additional procedures and measures may be necessary to confirm an OAB diagnosis, exclude other disorders and inform the treatment plan, such as:
- a urine culture and/or post-void residual assessment
- use of bladder diaries
- symptom questionnaires.
The cause of OAB is different in men and women, and other diagnoses are important to exclude, particularly in older patients.
The decision whether to perform cystoscopy should be made with consideration that OAB can be a symptom of CIS, bladder cancer, bladder stones or stricture.
Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth international consultation on incontinence recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourology Urodynamics. 2010; 29(1): 213-40.
Corcos J, Przydacz M, Campeau L, Witten J, Hickling D, Honeine C, et al. Canadian Urological Association (CUA) guideline on adult overactive bladder. Canadian Urology Association Journal 2017;11(5):E142-73.
Gormley EA, Lightner DJ, Burgio KL, Chai TC, Quentin Clemens J, Culkin DJ, et al. Diagnosis and treatment of non-neurogenic overactive bladder (OAB) in adults: an AUA/SUFU guideline (2019). Linthicum (MD): 2019 [cited 2020 Jun 19].
Tse V, King J, Dowling C, English S, Gray K, Millard R, et al. Conjoint Urological Society of Australia and New Zealand (USANZ) and Urogynaecological Society of Australasia (UGSA) guidelines on the management of adult non-neurogenic overactive bladder (Version: 1.0). Melbourne (VIC): UroGynaecological Society of Australasia. 2015 Jul [cited 2020 Jun 18].