Common symptoms of overactive bladder syndrome include urinary frequency, urgency, nocturia, and even urge incontinence.

In the outpatient department of the medical center, there are often patients who have undergone initial treatment at other institutions but have not seen significant improvement.

Should we directly recommend that patients undergo further invasive tests or treatments?

No, we should try to reexamine the treatment process for patients and identify possible treatment options.

1. Adequate behavior therapy?

• Have you tried adjusting your lifestyle and habits?
• Do you understand how to perform bladder training and pelvic floor muscle exercises?

2. Any other treatable disease been ruled out? Common conditions include:

• Urinary tract infections, stones, or tumors
• Atrophic vaginitis in menopausal women
• Pelvic organ prolapse
• Polyuria associated with diabetes

3. Attempt to increase the dosage of the medication without increasing side effects

Typically, medications commonly used for overactive bladder syndrome are extended-release tablets taken once daily, including 4mg of Detrusitol and 5mg of Vesicare. Additionally, according to the reference, Oxybutynin 5mg can be increased based on clinical needs up to six tablets per day; Propiverine 15mg can be increased based on clinical needs up to four tablets per day. Mirabegron can be adjusted clinically to either 25mg or 50mg dosage. In clinical practice, if a single drug response is poor, the common approach is to combine Mirabegron with other medications.

Some literature in western countries suggests that attempting to increase the dosage of commonly used medications can achieve better therapeutic effects, and even if the recommended dosage in the reference is exceeded, it is still safe to use. These include:

• Increasing Vesicare dosage up to 10mg daily.
• Increasing Detrusitol dosage up to 16mg daily.

These studies also found that using previously less commonly combined medications can yield better therapeutic effects while still being safe. These combinations include:

• Combining Detrusitol 4mg with Oxybutynin 5mg, then adjusting the dosage based on clinical needs.
• Combining Detrusitol 4mg with Vesicare 5mg, then adjusting the dosage based on clinical needs.
• Combining Oxybutynin 5mg with Vesicare 5mg, then adjusting the dosage based on clinical needs.

Conclusion: Each patient’s condition is unique. It is recommended to have a detailed discussion with a physician and jointly decide on the best treatment approach for oneself.