A 45-year-old woman complains of urine leakage when she laughs or coughs. Urodynamic study shows involuntary detrusor contractions during filling phase. The most appropriate first-line medical treatment is:

• A Pelvic floor muscle training (Kegel exercises)
• B Duloxetine 40 mg BD
• C Mid-urethral sling procedure
• D Antimuscarinic agent (e.g., oxybutynin or solifenacin) ✓

Explanation

The urodynamic finding of involuntary detrusor contractions during the filling phase defines overactive bladder (OAB) with urge urinary incontinence, not stress incontinence. The first-line medical treatment is antimuscarinic (anticholinergic) agents such as oxybutynin, solifenacin, or tolterodine. Pelvic floor exercises and duloxetine are treatments for stress urinary incontinence. Mid-urethral sling is surgical treatment for urodynamic stress incontinence.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.