is not palpable. The genitourinary examination in women should include a pelvic examination to rule out an obstruct- ing, kinking cystocele, atrophic vaginitis, and urethral diver- ticulum (palpable mass), and a rectal examination to rule out constipation, which can lead to OAB. In the male the size of the prostate and assessment for nodules is performed. Neuro- logic examination should include lumbar and sacral reﬂexes (anal wink, cremasteric, perianal sensation, bulbocavernosus reﬂex, anal sphincter tone) as well as mental status. The properly collected and processed urinalysis is a mainstay in evaluation of OAB. Hematuria, glucosuria, proteinuria, and infection can be easily identiﬁed. If the urine dip is positive, it is imperative to send the specimen for microscopic examination. Hematuria is deﬁned as 3 red blood cells per high power ﬁeld on two separate good quality specimens and should prompt comprehensive evalu- ation for neoplasm (renal mass protocol upper tract imaging, cystoscopy, and urine cytology) (Grossﬁeld et al 2001a, b). Mensturation and vulvovaginal atrophy can contaminate the sample in women; recollection or catheterized specimens can be helpful. The importance of obtaining a post void residual urine volume in the evaluation of OAB cannot be emphasized enough. This procedure can be performed by straight cath- eterization or bladder scanner in the ofﬁce, or by ultrasound in radiology. Incomplete emptying is a common and potentially dangerous cause of OAB. It should be screened for in all new OAB patients. Incomplete emptying is more likely in those with cystocele or prostatic obstruction, neurogenic bladder, urinary tract infections, diabetes, and overﬂow (unawares) incontinence. Serum creatinine is helpful in screening for compromised renal function. It is recommended (and can be complemented by renal ultrasound) in those with incomplete bladder emp- tying and suspected obstruction by pelvic organ prolapse, the prostate, or high-pressure neurogenic voiding dys- function. Serum glucose should be obtained in those with polydypsia/polyuria, if diabetes is suspected. Behavioral intervention Intervention on reversible causes of OAB should be diagnosis-speciﬁc, for example reduction of a cystocele and removal of bladder tumor. Once these discreet diagno- ses have been ruled out, treatment of uncomplicated OAB can begin. Behavioral intervention should always include patient education. Timed voiding in infrequent voiders or in patients with prior central nervous system injury (eg, stroke), decreased ﬂuid consumption in those with poly- Clinical Interventions in Aging 2008:3(3) Darifenacin for overactive bladder dypsia or night-time ﬂuid intake, caffeine modiﬁcation, and proper time of diuretic administration are all obvious places to start. Biofeedback pelvic ﬂoor muscle retraining can be used to relax any contributory pelvic ﬂoor muscle spasm and to educate patients on manipulation of bladder inhibitory reﬂexes. Unfortunately no peer-reviewed publication speciﬁ- cally exists for the use of biofeedback in OAB. However, a meta-analysis by Berghmans et al assessing the efﬁcacy of biofeedback in urge urinary incontinence found that almost all studies had positive results in favor of biofeedback but better constructed studies were needed to really evaluate its efﬁcacy (Berghmans et al 2000). Pharmacologic intervention There are many medications available for the management of uncomplicated OAB. Several agents previously used include propantheline, hyoscyamine, and imipramine. Propantheline bromide is a non-selective muscarinic receptor antagonist with low or varying bioavailability, with less frequent dos- ing and a larger side-effect burden (Nabi et al 2006). It is no longer applied for the treatment of OAB. Hyoscyamine sulfate, another muscarinic receptor antagonist, may be useful in patients with intermittent symptoms (Malone and Okano 1999). Its side effect proﬁle includes prominent anticholin- ergic side effects. Imipramine, a tricyclic antidepressant, is not routinely recommended for the treatment of OAB, but may be useful for stress incontinence or mixed urge – stress incontinence due to its effect on bladder neck tone (Wein 1998). Imipramine is associated with potentially serious CNS side effects and cardiotoxicity. More frequently prescribed agents for the treatment of OAB are oxybutynin, which has a mixed action, and tolterodine. Three additional drugs were approved by the US Food and Drug Administration in 2004 to treat the symptoms of OAB: trospium, which has been in use in Europe for the treatment of OAB, darifenacin, and solifenacin (Lam and Hilas 2007). Oxybutynin is one of the less selective muscarinic recep- tor antagonists (Schaefer 2007). Oxybutynin is available in 3 different formulations: immediate-release (taken twice daily), extended-release (taken once daily), and a transdermal patch (applied once every 3.5 days). Each has its own clinical niche. For instance, oxybutynin immediate release may be useful as a single dose in the evening for patients with nocturia who do not have troubling symptoms during the day. Oxybutynin-ER has a wide dosing range from 5 mg to 30 mg. This facilitates a dosing regimen that allows for a good balance between efﬁcacy and tolerability. Oxybutynin is also available in a transdermal patch. Due to the fact 505