A 45-year-old woman complains of involuntary leakage of urine on coughing, laughing, and sneezing. She has no urge or nocturia. Urodynamics shows normal detrusor pressure, bladder neck descent on Valsalva, and involuntary urethral pressure drop with increased abdominal pressure. The diagnosis and first-line non-surgical treatment is:
- A Stress urinary incontinence; supervised pelvic floor muscle training (Kegel exercises) ✓
- B Overactive bladder; antimuscarinics (oxybutynin)
- C Mixed urinary incontinence; duloxetine therapy
- D Detrusor overactivity; mirabegron (beta-3 agonist)
Explanation
The clinical and urodynamic picture is classic for genuine stress urinary incontinence (GSI): involuntary urine leakage with increased intra-abdominal pressure, no detrusor overactivity, and bladder neck descent. First-line management per EAU and NICE guidelines is supervised pelvic floor muscle training (PFMT) for at least 3 months, which strengthens the urethral sphincter mechanism and reduces leakage episodes by 50–70%. Antimuscarinics/mirabegron are for overactive bladder (detrusor overactivity). Duloxetine (SNRI) enhances sphincter tone and is a second-line pharmacological option for SUI.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.