OAB: Burden, Diagnosis, and the Guideline's New Framework

Overactive bladder (OAB) affects a substantial proportion of the adult population—approximately 40% of cisgender women and 20% of cisgender men—with prevalence rising with age, yet the condition frequently goes undiagnosed or inadequately treated for years. In the first segment of this series, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES founder, Fosnight Center for Sexual Health in Asheville, North Carolina, introduces her practice background and the clinical and human dimensions of OAB, situating the diagnosis as a symptom-based, quality-of-life condition in which patient bother—not laboratory findings—defines disease severity. Fosnight emphasizes that when OAB goes untreated, the consequences extend well beyond urinary symptoms, driving falls, sleep disruption, social isolation, depression, and sexual avoidance.

Fosnight describes her practice as rooted in patient agency, trauma-informed care, and weight-inclusive principles, and she frames her approach to OAB management accordingly. Rather than guiding patients through a predetermined treatment sequence, she has long presented the full range of available options at the outset of the clinical encounter, allowing patients' own goals and values to shape the plan. The 2024 AUA/SUFU guideline's elimination of mandatory step therapy and its formal adoption of shared decision-making as the organizing framework of OAB care, she notes, is an affirmation of what patient-centered practice has always required—not a departure from prior standards, but a codification of them.

Fosnight acknowledges that the guideline change carries practical significance beyond her own practice: It provides clinicians who have felt constrained by step-therapy requirements—whether through prior authorization demands, institutional habit, or training reflexes—with explicit professional support for offering minimally invasive therapies earlier and tailoring the treatment plan to the individual patient. She describes the shift as meaningful not because it changed her own workflow but because it expands access to individualized care for patients whose clinicians previously lacked guideline backing to deviate from a rigid ladder.