AUA/SUFU Overactive Bladder Guidelines Emphasize Shared Decision-Making - Ariana Smith

May 20, 2024

Diane Newman interviews Ariana Smith about the newly released AUA/SUFU Overactive Bladder Guidelines. Dr. Smith, who co-chaired the guidelines, emphasizes the shift from a stepwise therapy approach to a patient-centered menu of treatment options. This new guideline encourages shared decision-making, allowing patients to consider all treatments upfront based on their personal values and goals. It includes evidence for treating overactive bladder in all genders, addressing a gap in previous literature that focused mainly on women. The guidelines also support the use of telemedicine for initial assessments, increasing access to care. Dr. Smith highlights the importance of a thorough medical history and urinalysis, which can now be facilitated through telehealth visits, improving treatment initiation for more individuals. The discussion underscores the significance of informed decision-making in managing overactive bladder.


Ariana L. Smith, MD, Urologist, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA

Diane K. Newman, DNP, ANP-BC, BCB-PMD, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania, and Former Co-Director of the Penn Center for Continence and Pelvic Health, Philadelphia, PA

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Diane Newman: Welcome. I'm Diane Newman. I'm a nurse practitioner. I'm here at the AUA meeting in San Antonio, and I have with me a guest who's a colleague of mine at the University of Pennsylvania, Ariana Smith. She's a urologist, and she was the co-chair of the AUA Overactive Bladder Guidelines. Can you give us a summary of it and what has been changed with this guideline?

Ariana Smith: Yeah, thanks, Diane. It's great to see you. We just released the new SUFU/AUA guideline, and this is a new guideline. This is not an update from a prior guideline, and this new guideline really emphasizes shared decision-making with our patients. It really brings this to another level. We've moved away from the conventional STEP therapy, sometimes referred to as the first, second, and third line approach, and brought it more to a menu of options for our patients to discuss with their clinicians to determine the best treatment modality for that particular patient.

Diane Newman: Now, what is first line? So what do you recommend as maybe the first step for treatment of overactive bladder?

Ariana Smith: Well, first of all, we want patients to hear about all of the options. Instead of telling them they must go through behavioral changes, fluid restrictions, and then must take medication therapy before they can consider any other more invasive options, we want them to hear about all of these treatments upfront. We want them to think about their personal values and their goals. I'm sure you remember lots of people objecting to the use of medications, and now we have more and more data about safety issues with some of the medications we're offering patients. We need to give patients other alternatives. What we're proposing is that we offer patients a menu of options categorized by the level of invasiveness. All those first-line therapies are still there. They're still on our menu, and we're still allowing everyone to see all of the options, but we're not dictating that they take a stepwise approach through those options.

Diane Newman: Now, I'm sure you did an evidence-based review of all the different treatments in this field, and it's for individuals with non-neurogenic overactive bladder, correct?

Ariana Smith: That's right, Diane. This new guideline includes all genders. It is not specific to only women. There are limitations in the evidence base, the references that are available, because there haven't been a lot of studies on all genders, right? Most of the literature is on women. But what we were able to add is evidence in people with prostates. So we now have guidelines that can address overactive bladder symptoms in people with prostates, and not all urinary symptoms are the result of the prostate, right? Men have overactive bladder. People with prostates have overactive bladder, and now we can address those symptoms through guideline-based care.

Diane Newman: Was anything updated as far as the assessment of patients with overactive bladder?

Ariana Smith: Yeah. You know what's really great? We now have guidelines to support the use of telemedicine.

Diane Newman: Oh, great.

Ariana Smith: First, when we evaluate a patient with overactive bladder, we want to do a thorough medical history. We want to do a comprehensive system assessment. A physical exam is important, and a urinalysis is important, but with telemedicine, we can defer that physical exam. We can ask all the questions we need to ask, and we can send the patient for a urinalysis at the laboratory. When they come back in for their follow-up, we can then do their physical exam. We think this is safe. We think we'll be able to initiate care in more individuals, really increase the access. So many people have this condition and are not treated, and now we'll open up another avenue for potential treatment.

Diane Newman: That is a really great change, isn't it? Because you're right, there's such an underreporting of this problem and especially women don't come forward. The fact that we could do it with the telehealth visit makes a lot of sense.

Ariana Smith: Yeah. We're really excited about that addition to the guideline.

Diane Newman: Well, thank you very much for coming and explaining this to us because I think that we've been waiting for this updated guideline, so I'm glad that you say that we have much more about informed decision-making of the patient. So thanks.

Ariana Smith: Yeah, absolutely. Thanks for having me, Diane.