A 58-year-old multiparous woman presents with urinary leakage on coughing and sneezing. Urodynamic study shows involuntary detrusor contractions at 150 mL during filling phase with simultaneous leakage. What is the diagnosis and first-line treatment?

• A Genuine stress incontinence — midurethral sling (TVT)
• B Detrusor overactivity (urge incontinence) — bladder training and antimuscarinic therapy ✓
• C Mixed urinary incontinence — pelvic floor muscle training alone
• D Overflow incontinence — clean intermittent self-catheterisation

Explanation

Involuntary detrusor contractions during the filling phase on cystometry (urodynamic confirmation) is diagnostic of detrusor overactivity (OAB/urge incontinence). First-line treatment is bladder training (timed voiding) combined with antimuscarinic agents (oxybutynin, solifenacin) or beta-3 adrenergic agonists (mirabegron). Stress urinary incontinence shows urine leakage coinciding with increased intra-abdominal pressure without detrusor contraction. TVT is appropriate for stress incontinence, not detrusor overactivity.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.