The Overactive and Poorly Compliant Bladder: a Review of Coexisting Detrusor Overactivity and Poor Compliance

Abstract Purpose of Review Overactive bladder (OAB) and poorly compliant bladder are two urologic conditions that share overlapping symptoms, such as urinary frequency and incontinence, but arise from distinct etiologies. This review briefly outlines their pathophysiology and summarizes current management strategies. Recent Findings OAB is a clinical diagnosis defined by the hallmark symptom of urgency, whereas poorly compliant bladder is a urodynamic finding characterized by elevated storage pressures that can threaten upper tract function, leading to stone formation, recurrent urinary tract infections, and renal insufficiency. Initial management of OAB begins with behavioral therapy, followed by pharmacologic treatment. The two main classes are antimuscarinics and β3-agonists. Minimally invasive therapies, including onabotulinumtoxinA and neuromodulation, represent subsequent options. When conservative and minimally invasive treatments fail, surgical options such as augmentation cystoplasty or ileal conduit diversion may be considered. Summary Current management focuses on symptom relief in OAB and stabilization of bladder pressures in poorly compliant bladder. Emerging therapies—including repetitive transcranial magnetic stimulation (rTMS) for OAB and antifibrotics, anti-inflammatory agents, and stem cell-based approaches for poorly compliant bladder—are under investigation, with the potential to restore bladder function through tissue regeneration.