A 52-year-old woman complains of urgency, frequency, nocturia, and urge incontinence for 6 months. She has no stress leakage on cough test and no prolapse. Urinalysis is normal. The FIRST-LINE treatment is:
- A Bladder training, pelvic floor exercises, and fluid advice ✓
- B Oxybutynin immediate-release 5 mg three times daily
- C Botulinum toxin A 100 units intradetrusor injection
- D Sacral neuromodulation (InterStim)
Correct answer: A. Bladder training, pelvic floor exercises, and fluid advice
Explanation
NICE guidelines for overactive bladder (OAB) and urgency urinary incontinence recommend conservative management as first-line: bladder training (retraining the micturition interval), pelvic floor muscle exercises, caffeine reduction, fluid optimization (1.5–2 L/day), and weight loss if obese. These non-pharmacological measures should precede antimuscarinic medications. Antimuscarinics (oxybutynin, tolterodine, solifenacin) are second-line after failed conservative management. Botulinum toxin and neuromodulation are third-line for refractory cases.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.