Timing for evaluation

The timing of evaluation in patients with an overactive bladder (OAB) remains elusive. With the advent of more numerous drug treatments and formulations for OAB symptoms and marketing campaigns to a broader public, the trend has been to involve primary care physicians in the early prescription of these treatments, often times with limited evaluation and a heavy reliance on symptomatology and degree of bothersomeness to initiate therapy. Once this initial approached failed because of drug side-effects, limited clinical response, and/or cost issues, a referral to a specialist is sometimes considered. Therefore, the ease of drug prescription has undoubtedly affected the timing of evaluation, and delayed it for the most part. Recognizing patients who could benefit from a specialist evaluation is important to confirm the OAB diagnosis and provide a more targeted management. Data on timing of evaluation is sparse as this field is now emerging and has not been very well studied. This review provides directions on timing of evaluation, with a reminder that OAB symptoms can mask a variety of other diagnoses requiring specific therapies.