Review of the Impact and Burden of Urinary Urgency on Adults with Overactive Bladder

Overactive bladder (OAB) is a prevalent condition that impairs the quality of life in both men and women, and for many, urgency is the most bothersome symptom. Urgency is thought to drive the presentation of the other symptoms (frequency, nocturia, urgency urinary incontinence [UUI]). However, urgency has been understudied in clinical trials, potentially owing to inherent difficulties in its assessment. The definition of urgency related to OAB has been refined over the years, but it may not be easily understood by patients and clinicians, affecting its use in practice. Variability among the tools to measure urgency further complicates the matter. For example, some measure the frequency of urgency episodes and consider reduction of episode frequency as improvement in urgency severity. Others rate the severity of each episode of urgency along a scale, with some including an accompanying incontinence episode as the most severe form. Reduction in UUI episodes is often a primary endpoint in clinical studies, with many studies requiring UUI—sometimes called OAB-wet—as an inclusion criterion, yet approximately two-thirds of those with OAB do not experience UUI. If patients with OAB without UUI (i.e., OAB-dry) are included, they are often not analyzed separately. Thus, it remains unknown if there are differences in treatment outcomes between patients with and without UUI and whether these differences are driven by pathophysiological processes. This narrative review highlights what is known about the pathophysiology of urgency, how urgency affects individuals with OAB, urgency measurement and associated challenges, and assessment of urgency in clinical trials.