A 48-year-old multiparous woman complains of urgency, frequency, nocturia, and urge incontinence for one year. Urine culture is sterile. Bladder diary shows 12 micturitions per day. Ultrasound shows no residual urine and no pelvic pathology. After failure of bladder training and timed voiding over 8 weeks, which drug is the appropriate next step?

• A Desmopressin
• B Duloxetine
• C Imipramine
• D Oxybutynin ✓

Explanation

This woman has idiopathic detrusor overactivity (overactive bladder syndrome), confirmed by sterile urine, normal residual volume, and urge-predominant symptoms. Behavioural therapy failed, so an antimuscarinic agent such as oxybutynin, solifenacin, or tolterodine is the accepted second step. Duloxetine is a serotonin-noradrenaline reuptake inhibitor used for stress incontinence, desmopressin is reserved for troublesome nocturnal polyuria, and imipramine is a third-line agent with significant cardiac toxicity.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.