Incontinence uncovered: Managing urgency without stress at EAU26

On Monday, 16 March 2026, the thematic session ‘Incontinence Uncovered: Managing Urgency Without Stress’  took place at the annual EAU Congress in London. Chaired by E. Finazzi Agrò (Rome, IT) and B. Peyronnet (Rennes, FR), the session focused on the latest prevention strategies, diagnostic pathways, and treatments for overactive bladder (OAB) in both men and women, as well as stress urinary incontinence (SUI) in female patients. A panel of international experts shared insights into the evolving landscape of urological care, with an emphasis on patient-centered approaches and innovation in treatment strategies.

M.R. Van Balken (Arnhem, NL) opened the session with an overview of the Urge to Act campaign, highlighting the need to recognize urinary incontinence not only as a bothersome condition but also as a chronic disease with significant social and economic implications. He stressed that raising awareness among policymakers is crucial, particularly because urinary incontinence often coexists with other chronic conditions, influencing health resource allocation and care priorities.

Van Balken emphasized that demonstrating the burden of OAB through patient-reported outcomes can strengthen advocacy efforts. He congratulated the Urge to Act team on their progress and encouraged continued focus on elevating the condition as a priority for healthcare sustainability.

L. Wiemer (Berlin, DE) discussed the role of digital solutions in supporting patients with OAB. Apps and digital platforms can translate guideline recommendations into daily practice efficiently, reduce time spent on patient education, and support structured, long-term follow-up. These tools facilitate multimodal therapy, enhance patient empowerment, and can be reimbursed by public health systems in countries like Germany. While adoption depends on both digital literacy and physician engagement, the benefits include symptom reduction across urgency, frequency, nocturia, and urge urinary incontinence (UUI), with little to no side effects.

P. Igualada-Martinez (London, GB) highlighted physiotherapy as a multimodal, first-line intervention endorsed by major guidelines. Techniques include supervised pelvic floor muscle training (PFMT), bladder training, functional exercise, falls risk management, and lifestyle interventions. Personalized therapy is key, with interventions tailored to patient needs, severity, and coexisting conditions. Physiotherapy promotes patient activation, self-management, and long-term symptom control, serving as a foundation that enhances the effectiveness of complementary treatments, including medications and digital therapies.

C. Hentzen (Paris, FR) presented evidence for transcutaneous tibial nerve stimulation (TTNS), a non-invasive, patient-administered technique using surface electrodes. TTNS has been shown to reduce urgency and frequency effectively, with comparable efficacy to percutaneous stimulation (PTNS) but with greater comfort and convenience. Low side-effect profiles make TTNS a safe and feasible option, particularly suitable for patients seeking non-pharmacological interventions.

M.C. Lapitan (Manila, PH) reviewed antimuscarinic therapy, emphasizing rapid onset, reversibility, and predictable symptom control. While behavioral therapy requires voluntary suppression of involuntary detrusor activity, antimuscarinics act directly at the receptor level, making them a preferred pharmacologic option for many patients who prioritize rapid and reliable symptom relief. Side effects, such as dry mouth, are generally tolerable.

S.Y. Cho (Seoul, KR) highlighted the efficacy and long-term safety of beta-3 agonists like mirabegron. Clinical trials (SCORPIO, TAURUS, BESIDE) confirm symptom improvement and low rates of anticholinergic adverse effects. Mirabegron is effective as monotherapy, in combination with antimuscarinics, and in neurogenic bladder patients without detrusor sphincter dyssynergia (DSD), supporting broader applicability.

The panel emphasized the need for a personalized, non-stepwise approach to OAB. George highlighted that OAB is a symptom syndrome with variable longitudinal evolution. Treatment should be tailored based on patient profile, severity, and comorbidities. Conservative interventions—including physiotherapy, behavioral therapy, and digital self-management—remain first-line, with medications added for urgent relief when needed. Shared decision-making ensures alignment with patient preferences.

M.S. Abdel-Fattah (Aberdeen, GB) argued that urodynamics is now very limited in guiding routine OAB treatment, whereas T. Tarcan (Istanbul, TR) maintained its paramount importance in complex cases. The discussion concluded that comprehensive clinical assessment should guide individualized care, with urodynamics reserved for selected scenarios where diagnosis or treatment choice is uncertain. 

M. Belal (Birmingham, GB) highlighted the importance of involving patients in treatment choices, considering lifestyle, symptom severity, and personal preferences. Shared decision-making supports better adherence, patient empowerment, and optimized outcomes.

The session reinforced that effective management of OAB and SUI requires a multimodal, patient-centered approach. Early conservative therapy, digital self-management, physiotherapy, behavioral interventions, and carefully selected pharmacologic options can improve outcomes while minimizing adverse effects. Tailoring treatment to individual needs, shared decision-making, and integrating innovative approaches such as TTNS represent the future of urological care.

By combining guideline-based practice, patient empowerment, and targeted interventions, clinicians can reduce the burden of urinary incontinence and enhance quality of life for patients worldwide.