Overactive bladder - Diagnosis and treatment (2023)

Diagnosis

If you have unusual urges to urinate, your health care provider will check to make sure that you don't have an infection or blood in your urine. Your provider may also want to make sure that you're emptying your bladder completely when you urinate.

Your provider will look for clues that might also indicate contributing factors. Your appointment will likely include a:

  • Medical history
  • Physical exam, which may include a rectal exam and a pelvic exam in women
  • Urine sample to test for infection, traces of blood or other abnormalities
  • Focused neurological exam that may identify sensory issues or reflex problems

Tests of bladder function

Your provider may recommend tests to assess how well your bladder is functioning and its ability to empty steadily and completely (urodynamic tests). These tests usually require a referral to a specialist, but testing may not be necessary to make a diagnosis or begin treatment. Urodynamic tests include:

  • Measuring urine left in the bladder. This test is important if there's concern about your ability to empty your bladder completely when you urinate. Remaining urine in the bladder (post-void residual urine) may cause symptoms identical to those of an overactive bladder.

    To measure residual urine after you have voided, your doctor may request an ultrasound scan of your bladder. The ultrasound scan translates sound waves into an image, showing how much urine is left in your bladder after you urinate. In some cases, a thin tube (catheter) is passed through the urethra and into your bladder to drain the remaining urine, which can then be measured.

  • Measuring urine flow rate. To measure the volume and speed of your voiding, you may be asked to urinate into a device (uroflowmeter). A uroflowmeter catches and measures the urine, and translates the data into a graph of changes in your flow rate.
  • Testing bladder pressures. Cystometry is a test that measures pressure in your bladder and in the surrounding region as your bladder fills. During this test, your doctor uses a thin tube (catheter) to fill your bladder slowly with warm fluid. Another catheter with a pressure-measuring sensor is placed in the rectum or, for women, inthe vagina. The sensor tells how much pressure your bladder has to exert to empty completely.

    This procedure can identify whether you have involuntary muscle contractions or a stiff bladder that's not able to store urine under low pressure.

Your doctor will review the results of any tests with you and suggest a treatment strategy.

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More Information

  • Overactive bladder care at Mayo Clinic
  • Urinalysis

Treatment

A combination of treatment strategies may be the best approach to relieve overactive bladder symptoms.

(Video) Overactive Bladder, Causes, Signs and Symptoms, Diagnosis and Treatment.

Behavioral therapies

Male pelvic floor muscles

Overactive bladder - Diagnosis and treatment (2)

Male pelvic floor muscles

The pelvic floor muscles support the bladder and bowel and affect sexual function. Kegel exercises can help strengthen these muscles.

(Video) Treatment for Overactive Bladder & Urge Incontinence, Dr. Ja-Hong Kim | UCLAMDChat

Behavioral interventions are the first choice in helping manage an overactive bladder. They're often effective, and they carry no side effects. Behavioral interventions may include:

  • Pelvic floor muscle exercises. Kegel exercises strengthen your pelvic floor muscles and urinary sphincter. These strengthened muscles can help you stop the bladder's involuntary contractions.

    Your doctor or a physical therapist can help you learn how to do Kegel exercises correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.

  • Biofeedback. During biofeedback, you're connected to electrical sensors that help you measure and receive information about your body. The biofeedback sensors teach you how to make subtle changes in your body, such as strengthening your pelvic muscles so that when you have feelings of urgency you're better able to suppress them.
  • Healthy weight. If you're overweight, losing weight may ease symptoms. Weight loss may help if you also have stress urinary incontinence.
  • Scheduled toilet trips. Setting a schedule for toileting — for example, every two to four hours — gets you on track to urinate at the same times every day rather than waiting until you feel the urge to urinate.
  • Intermittent catheterization. If you are not able to empty your bladder well, using a catheter periodically to empty your bladder completely helps your bladder do what it can't do by itself. Ask your doctor if this approach is right for you.
  • Absorbent pads. Wearing absorbent pads or undergarments can protect your clothing and help you avoid embarrassing incidents, which means that you won't have to limit your activities. Absorbent garments come in a variety of sizes and absorbency levels.
  • Bladder training. Bladder training involves training yourself to delay voiding when you feel an urge to urinate. You begin with small delays, such as 30 minutes, and gradually work your way up to urinating every three to four hours. Bladder training is possible only if you're able to tighten (contract) your pelvic floor muscles successfully.

Medications

After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in the form of cream, suppository, tablet, or ring, and can significantly improve symptoms of overactive bladder.

Medications that relax the bladder can be helpful for relieving symptoms of overactive bladder and reducing episodes of urge incontinence. These drugs include:

  • Tolterodine (Detrol)
  • Oxybutynin, which can be taken as a pill (Ditropan XL) or used as a skin patch (Oxytrol) or gel (Gelnique)
  • Trospium
  • Solifenacin (Vesicare)
  • Fesoterodine (Toviaz)
  • Mirabegron (Myrbetriq)

Common side effects of most of these drugs include dry eyes and dry mouth, but drinking water to quench thirst can aggravate symptoms of overactive bladder. Constipation — another potential side effect — can aggravate your bladder symptoms. Extended-release forms of these medications, including the skin patch or gel, may cause fewer side effects.

Your doctor may recommend that you sip small amounts of water or suck on a piece of sugar-free candy or chew sugar-free gum to relieve dry mouth, and use eyedrops to keep your eyes moist. Over-the-counter preparations, such as Biotene products, can be helpful for long-term dry mouth. To avoid constipation, your doctor might recommend a fiber-rich diet or use of stool softeners.

Bladder injections

OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Used in small doses directly injected into bladder tissues, this protein relaxes the muscles.

Studies show that it may be useful for severe urge incontinence. The temporary effects generally last six months or more, but repeat injections are necessary.

Side effects from these injections include urinary tract infections and urinary retention. If you're considering Botox treatments, you should be willing and able to catheterize yourself if urinary retention occurs.

Nerve stimulation

Sacral nerve stimulator

Overactive bladder - Diagnosis and treatment (3)

Sacral nerve stimulator

During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity (sacral nerves). The unit is placed beneath the skin of the buttocks, near the sacral nerves.

(Video) Overactive Bladder Symptoms & Treatments

Regulating the nerve impulses to your bladder can improve overactive bladder symptoms.

One procedure uses a thin wire placed close to the sacral nerves — which carry signals to your bladder — where they pass near your tailbone.

This minimally invasive procedure is often done with a trial of a temporary wire implanted under the skin in your lower back. Sometimes it may be done as an advanced procedure in which the permanent electrode is implanted and a longer trial is performed. Your doctor then uses a hand-held device connected to the wire to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart. If it helps with your symptoms, a permanent, battery-powered pulse generator is surgically implanted to help regulate the nerve rhythm.

Percutaneous tibial nerve stimulation (PTNS)

This procedure uses a thin needle that is placed through the skin near your ankle to send electrical stimulation from a nerve in your leg (tibial nerve) to your spine, where it connects with the nerves that control the bladder.

PTNS treatments are delivered once a week for 12 weeks to help treat symptoms of overactive bladder. You will likely need maintenance treatments every three to four weeks to keep symptoms under control.

Surgery

Surgery to treat overactive bladder is reserved for people with severe symptoms who don't respond to other treatments. The goal is to improve the bladder's ability to store urine and reduce pressure in the bladder. However, these procedures won't help relieve bladder pain. These procedures include:

  • Surgery to increase bladder capacity. This procedure uses pieces of your bowel to replace a portion of your bladder. This surgery is used only in cases of severe urge incontinence that doesn't respond to any other, more-conservative treatment measures. If you have this surgery, you may need to use a catheter intermittently for the rest of your life to empty your bladder.
  • Bladder removal. This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement bladder (neobladder) or an opening in the body (stoma) to attach a bag on the skin to collect urine.

More Information

  • Overactive bladder care at Mayo Clinic
  • Acupuncture
  • Biofeedback
  • Bladder removal surgery (cystectomy)
  • Botox injections
(Video) Overactive bladder (ओवरएक्टिव ब्लैडर) causes, symptoms & treatment (In Hindi) | Dr Shalabh Agrawal

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

These lifestyle strategies may reduce overactive bladder symptoms:

  • Maintain a healthy weight. If you're overweight, losing weight may ease your symptoms. Heavier people are also at greater risk of stress urinary incontinence, which may improve with weight loss.
  • Drink adequate amounts of fluid. Ask your doctor how much fluid you need daily. Drinking too much fluid can worsen your symptoms, but not drinking enough can make your urine become concentrated and can irritate the lining of your bladder. This increases the urge to urinate.
  • Limit foods and drinks that might irritate your bladder. Some foods and drinks that may irritate the bladder include caffeine, alcohol, tea, carbonated drinks, citrus juice and fruit, chocolate, spicy foods, and tomatoes. If any of these worsen your symptoms, it might be wise to avoid them.

Alternative medicine

No complementary or alternative therapies have been proved to successfully treat overactive bladder.

Research has suggested that acupuncture might help ease the symptoms of overactive bladder. Acupuncture practitioners treat you using extremely thin, disposable needles.

Complementary treatments may not be covered by insurance, so check with your insurance company first.

Coping and support

Living with overactive bladder can be difficult. Consumer education and advocacy support groups such as the National Association for Continence can provide you with online resources and information, connecting you with people who experience overactive bladder and urge incontinence. Support groups offer the opportunity to voice concerns, learn new coping strategies and stay motivated to maintain self-care strategies.

Educating your family and friends about overactive bladder and your experiences with it may help you establish your own support network and reduce feelings of embarrassment. Once you start talking about it, you may be surprised to learn how common this condition really is.

Preparing for your appointment

For overactive bladder, you're likely to start by seeing your primary doctor. After your initial appointment, you may be referred to a specialist in urinary disorders in men and women (urologist), a specialist in urinary disorders in women (urogynecologist), or a specialist in physical therapy for diagnosis and treatment.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Keep a bladder diary for a few days, recording when, how much and what kind of fluids you consume, when you urinate, whether you feel an urge to urinate, and whether you experience incontinence. A bladder diary may help determine why you have to get up to urinate at night.
  • Tell your doctor how long you've had your symptoms and how they affect your day-to-day activities.
  • Note any other symptoms you're experiencing, particularly those related to your bowel function.
  • Let your doctor know if you have diabetes, have a neurological disease, or have had pelvic surgery or radiation treatments.
  • Make a list of all the medications, vitamins or supplements you take; many medications can affect bladder function.
  • Write down questions to ask your doctor.

For overactive bladder, basic questions might include:

  • What are the possible causes of my symptoms?
  • Is my urine clear?
  • Do I empty my bladder well?
  • Is my pelvic floor muscle strength good enough for me to keep my bladder from contracting when I have an abnormal urge?
  • Do you recommend any other tests? Why?
  • What treatments are available, and which do you recommend for me?
  • What side effects can I expect from treatment?
  • Are there any dietary restrictions that could help?
  • How do my other health problems affect my bladder symptoms?
  • If I need to see a specialist, what can I expect?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

What to expect from your doctor

Your doctor may use an overactive bladder questionnaire to make an assessment of your symptoms, asking questions such as:

(Video) Overactive Bladder: Causes, Symptoms and Treatment

  • How long have you had these symptoms?
  • Do you unexpectedly leak urine? How often?
  • What do your symptoms keep you from doing that you like to do?
  • During daily activities, such as walking or bending over, do you leak urine?

By Mayo Clinic Staff

FAQs

How is an overactive bladder diagnosed? ›

In most cases OAB can be diagnosed by history and physical exam and a urine analysis to rule out infection or blood in the urine. An abnormal urine analysis may prompt treatment (if infection is found) or further testing (if blood is found). Sometime you doctor will check to see if your bladder is emptying well.

How long is the treatment for overactive bladder? ›

However, it can take up to 4 to 8 weeks for you to notice any improvements in your symptoms. Usually, treatment with mirabegron is long term. However, if you no longer have bladder problems, your doctor will advise you to stop taking mirabegron.

Can you recover from overactive bladder? ›

More often than not, OAB is a chronic condition; it can get better, but it may not ever go away completely. To start with, doctors often recommend exercises such as Kegels to strengthen pelvic floor muscles and give you more control over your urine flow.

What is the newest medication for overactive bladder? ›

Mirabegron is the first drug in a new class of oral therapy for overactive bladder (OAB).

What vitamin helps with bladder control? ›

Conclusions: High-dose intakes of vitamin C and calcium were positively associated with urinary storage or incontinence, whereas vitamin C and β-cryptoxanthin from foods and beverages were inversely associated with voiding symptoms.

What will a urologist do for overactive bladder? ›

Treatment for Overactive Bladder

Our urologists treat patients with OAB with combinations of behavioral therapy, medication, and in severe cases, a therapy called Interstim, to treat overactive bladder. Another option is the injection of Botox into the bladder to relax and paralyze the overactive muscle.

What medication can stop frequent urination? ›

Anticholinergic medications include:
  • Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
  • Tolterodine (Detrol, Detrol LA)
  • Darifenacin.
  • Solifenacin (Vesicare, Vesicare LS)
  • Trospium.
  • Fesoterodine (Toviaz)

How is overactive bladder caused? ›

Overactive bladder describes a combination of symptoms that can include a frequent urge to urinate and waking up at night to urinate. Causes can include weak muscles, nerve damage, use of medications, alcohol or caffeine, infection, and being overweight. Lifestyle changes may help.

Do I have to take oxybutynin forever? ›

Do not take oxybutynin for longer than you need to. Your doctor will check every 6 to 12 months that your treatment is still needed.

What is the best supplement for overactive bladder? ›

Magnesium. Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence.

How do you calm an overactive bladder naturally? ›

Natural remedies
  1. Foods to avoid. Foods and drinks, which are known to cause or worsen the symptoms of OAB include: ...
  2. Manage fluid intake. Drinking enough water is essential for health. ...
  3. Scheduled urination. ...
  4. Delayed urination. ...
  5. Double-void technique. ...
  6. Kegel contractions. ...
  7. Quitting smoking. ...
  8. Discussing medications with a doctor.
24 Apr 2017

What aggravates an overactive bladder? ›

Bladder irritants

Coffee, tea and carbonated drinks, even without caffeine. Alcohol. Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices.

Can anxiety cause overactive bladder? ›

Stress, anxiety, and depression may actually contribute to OAB and urinary incontinence. In a study involving more than 16,000 women in Norway, having anxiety or depression symptoms at baseline was associated with a 1.5- to two-fold increase in the risk of developing urinary incontinence.

Does overactive bladder get worse with age? ›

Overactive bladder (OAB) is a common condition characterised by the symptoms of urinary frequency and urgency, with or without urge incontinence and nocturia. The prevalence of OAB increases markedly with age in both men and women.

Is there a pill for bladder control? ›

Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride.

What is the cheapest medication for overactive bladder? ›

Prices for popular overactive bladder medications
  • Ditropan XL (oxybutynin ER) as low as. $22. ...
  • oxybutynin. as low as. $20. ...
  • Hyosyne (hyoscyamine) as low as. $17. ...
  • Levsin (hyoscyamine) as low as. $17. ...
  • Myrbetriq. as low as. $427. ...
  • tolterodine ER. as low as. $38. ...
  • Vesicare. as low as. $383. ...
  • trospium. as low as. $24.

Is there a better drug than oxybutynin? ›

Because tolterodine ER demonstrates improved efficacy in terms of continuation compared with oxybutynin while costing less overall, pharmacists should consider tolterodine ER when making recommendations for overactive bladder.

Is banana good for overactive bladder? ›

Fruits - while some fruits, especially citrus, can irritate the bladder, it's still important to incorporate them into your diet. Bananas, apples, grapes, coconut and watermelon are good options for those with overactive bladder.

Does vitamin D Help overactive bladder? ›

Conclusions: Vitamin D supplements and improved calcium intake may improve urinary and psychological symptoms and quality of life among patients with OAB syndrome. Assessment for vitamin D status in patients with OAB may be warranted.

Can a urine test detect overactive bladder? ›

Urinalysis. Taking a urine sample allows your doctor to check for conditions that can cause overactive bladder.

Can you see overactive bladder on ultrasound? ›

Ultrasound imaging can detect bladder muscle overactivity by measuring the thickness of the bladder wall. Researchers have determined that a thicker bladder wall may be associated with OAB. Ultrasound imaging can also detect other underlying conditions that are responsible for OAB, such as bladder stones.

What are the four main symptoms of an overactive bladder? ›

These symptoms include:
  • Urinary urgency. Urinary urgency is a sudden, uncontrollable need to pee. ...
  • Frequent peeing. A frequent need to pee means you have to go to the bathroom more often than usual.
  • Urge incontinence. Urge incontinence is a sudden, uncontrollable need to pee, and you may leak pee.
  • Nocturia.
13 Sept 2022

Which medication relaxes bladder muscles? ›

Oxybutynin gel is in a class of medications called antimuscarinics. It works by relaxing the bladder muscles.

How do you train an overactive bladder? ›

Gradually increase the amount of time between bathroom breaks. Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom.

What are 3 treatment options for incontinence? ›

Incontinence products

absorbent products, such as pants or pads. handheld urinals. a catheter (a thin tube that is inserted into your bladder to drain urine) devices that are placed into the vagina or urethra to prevent urine leakage – for example, while you exercise.

Is overactive bladder a chronic illness? ›

Overactive bladder (OAB) syndrome is a chronic medical condition which has a tremendous impact on the quality of life in both men and women [1]. OAB affects performance of daily activities and social function such as work, traveling, physical exercise, sleep, and sexual function.

Is an overactive bladder a disability? ›

Loss of bladder control is a serious disorder that may impact your ability to work. If you have bladder control problems, you may be eligible for Social Security Disability Insurance (SSDI) or Long Term Disability (LTD) benefits.

Does drinking water help with overactive bladder? ›

Because the bladder can only hold so much fluid volume, increasing water intake will increase the frequency of urination, and may make people with an overactive bladder more likely to leak. If you have overactive bladder (OAB), more fluid intake typically equals more trips to the bathroom.

How do you calm an overactive bladder naturally? ›

Natural remedies
  1. Foods to avoid. Foods and drinks, which are known to cause or worsen the symptoms of OAB include: ...
  2. Manage fluid intake. Drinking enough water is essential for health. ...
  3. Scheduled urination. ...
  4. Delayed urination. ...
  5. Double-void technique. ...
  6. Kegel contractions. ...
  7. Quitting smoking. ...
  8. Discussing medications with a doctor.
24 Apr 2017

What is the best supplement for overactive bladder? ›

Magnesium. Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence.

What medication can stop frequent urination? ›

Anticholinergic medications include:
  • Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
  • Tolterodine (Detrol, Detrol LA)
  • Darifenacin.
  • Solifenacin (Vesicare, Vesicare LS)
  • Trospium.
  • Fesoterodine (Toviaz)

What are the four main symptoms of an overactive bladder? ›

These symptoms include:
  • Urinary urgency. Urinary urgency is a sudden, uncontrollable need to pee. ...
  • Frequent peeing. A frequent need to pee means you have to go to the bathroom more often than usual.
  • Urge incontinence. Urge incontinence is a sudden, uncontrollable need to pee, and you may leak pee.
  • Nocturia.
13 Sept 2022

What medications cause overactive bladder? ›

Pharmacologic agents including oral estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal anti-inflammatory drugs, and calcium channel blockers have been implicated to some degree in the onset or exacerbation of urinary incontinence.

What herb is good for overactive bladder? ›

Horsetail. Horsetail is an herb used to treat a variety of ailments. Among them are some symptoms of OAB including: urinary leaks (incontinence)

Does drinking water help with overactive bladder? ›

Because the bladder can only hold so much fluid volume, increasing water intake will increase the frequency of urination, and may make people with an overactive bladder more likely to leak. If you have overactive bladder (OAB), more fluid intake typically equals more trips to the bathroom.

Does vitamin D Help overactive bladder? ›

Conclusions: Vitamin D supplements and improved calcium intake may improve urinary and psychological symptoms and quality of life among patients with OAB syndrome. Assessment for vitamin D status in patients with OAB may be warranted.

What aggravates an overactive bladder? ›

Bladder irritants

Coffee, tea and carbonated drinks, even without caffeine. Alcohol. Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices.

Can vitamin D cause bladder problems? ›

Studies have found that low vitamin D levels are linked to overactive bladder. Overactive bladder is characterized by frequent urination, incontinence, nocturia (the need to urinate more than twice per night) and sudden, intense urges to urinate.

What is the cheapest medication for overactive bladder? ›

Prices for popular overactive bladder medications
  • Ditropan XL (oxybutynin ER) as low as. $22. ...
  • oxybutynin. as low as. $20. ...
  • Hyosyne (hyoscyamine) as low as. $17. ...
  • Levsin (hyoscyamine) as low as. $17. ...
  • Myrbetriq. as low as. $427. ...
  • tolterodine ER. as low as. $38. ...
  • Vesicare. as low as. $383. ...
  • trospium. as low as. $24.

Can anxiety cause overactive bladder? ›

Stress, anxiety, and depression may actually contribute to OAB and urinary incontinence. In a study involving more than 16,000 women in Norway, having anxiety or depression symptoms at baseline was associated with a 1.5- to two-fold increase in the risk of developing urinary incontinence.

How do you train an overactive bladder? ›

Gradually increase the amount of time between bathroom breaks. Delay urination. When you feel the urge to urinate, hold it for another five minutes or so. Then gradually increase the amount of time by 10 minutes, until you can last for at least three to four hours without having to go to the bathroom.

What can a urologist do for overactive bladder? ›

Our urologists treat patients with OAB with combinations of behavioral therapy, medication, and in severe cases, a therapy called Interstim, to treat overactive bladder. Another option is the injection of Botox into the bladder to relax and paralyze the overactive muscle.

Is overactive bladder lifelong? ›

Conversely, about 40% to 70% of urinary incontinence is due to overactive bladder. Overactive bladder is not life-threatening, but most people with the condition have problems for years.
...
Overactive bladder
DurationOften years
CausesUnknown
Risk factorsObesity, caffeine, constipation
10 more rows

Is overactive bladder a serious problem? ›

Overactive bladder is a combination of symptoms that can cause you to need to urinate more frequently, have more urgency, experience incontinence (leakage) and a need to urinate at night. One or all of these symptoms can cause considerable stress and a negative impact on your quality of life.

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3. Everything You Need to Know About Overactive Bladder (OAB) | #DeepDives | Health
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4. OverActive Bladder Syndrome
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5. AUAU Podcast: AUA/SUFU Diagnosis and Treatment and Non-Neurgenic Overactive Bladder in Adults
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