A 42-year-old woman reports sudden urges to urinate several times a day, nocturia twice nightly, and leakage before she reaches the toilet. She has no leakage on coughing. After failed bladder training and fluid advice, the first-line pharmacological therapy is:

• A Topical vaginal estrogen
• B Imipramine
• C A beta-3 agonist such as mirabegron as sole initial therapy
• D An antimuscarinic agent such as oxybutynin ✓

Explanation

Her symptoms define urge incontinence with overactive bladder, caused by idiopathic detrusor overactivity. When behavioral measures fail, antimuscarinics such as oxybutynin, tolterodine, solifenacin or fesoterodine are the established first-line drugs, acting on M3 receptors of the detrusor. Mirabegron is generally reserved as second line or when anticholinergic side effects limit use. Imipramine is an older agent with cardiac toxicity, and topical estrogen treats urogenital atrophy, not detrusor overactivity.

Reference: Campbell-Walsh-Wein Urology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.