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This narrative review discusses issues specific to the management of OAB in women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The review is based on discussions at a symposium held at the International Urogynecological Association\/European Urogynaecological Association meeting (Barcelona, Spain; June 2025) supplemented by a PubMed search of articles (published in English since 1 January 2020) describing current treatment practices, unmet clinical needs and future directions for the management of OAB in women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pathophysiology of OAB in women is multifactorial, involving detrusor overactivity, urothelial and sensory dysfunction, and central nervous system dysregulation, with additional contributions from hormonal and age-related changes. Management of OAB has evolved toward an individualised, stepwise approach. Behavioural and lifestyle interventions remain first-line therapy, followed by pharmacological options, such as antimuscarinics and \u03b23-adrenergic agonists. For refractory cases, onabotulinumtoxin A and neuromodulation are established third-line treatments. Local oestrogen therapy or prasterone may provide benefit in selected postmenopausal women, whereas radiofrequency and urethral bulking strategies remain investigational. Emerging evidence supports newer \u03b23-agonists, such as vibegron, which may provide comparable efficacy to established \u03b23-agonists (e.g. mirabegron) with improved cardiovascular tolerability. Treatment selection for women with OAB should consider comorbidities, drug safety, cognitive and cardiovascular risk in older patients, and challenges with adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Further research into underlying mechanisms, long-term outcomes and strategies to optimise treatment adherence will be essential to improve symptom control and quality of life for women living with OAB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-026-06471-5","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T08:39:37Z","timestamp":1780303177000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating the challenges of overactive bladder management in women"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4877-0640","authenticated-orcid":false,"given":"Andrea","family":"Braga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard B.","family":"Goldman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-3852","authenticated-orcid":false,"given":"Anna","family":"Padoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8534-646X","authenticated-orcid":false,"given":"Maurizio","family":"Serati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"5 Suppl 1","key":"6471_CR1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/s0090-4295(02)01784-3","volume":"60","author":"AJ Wein","year":"2002","unstructured":"Wein AJ, Rovner ES (2002) Definition and epidemiology of overactive bladder. 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Howard B. Goldman has received honoraria for consulting from Medtronic, AbbVie, Sumitomo Pharma, Pierre Fabre, Laborie, Boston Scientific, Iota and NewUro; was the chair of a Drug Safety Monitoring Board for Bluewind; and was a participant in a study sponsored by Cook. Anna Padoa has received speaker honoraria from Dexcel Pharma, Novo Nordisk and Pierre Fabre Medicament; received study funding and\/or travel support from Hikkonu and Arletta Pharma; received royalties from Springer Switzerland; participated on the advisory board at Tiki100; is an unpaid co-chair of the Education Committee at the European Urogynaecological Association (EUGA); and is the chair of the Female Sexual Dysfunction Scientific Committee at the European Society for Sexual Medicine (ESSM). Maurizio Serati has acted as a consultant for Pierre Fabre, Laborie and Coloplast.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}],"article-number":"400"}}