A 62-year-old woman with long-standing type 2 diabetes reports frequent small leaks of urine without warning. On examination the bladder is palpable above the symphysis pubis, sensation is diminished, and ultrasound shows a postvoid residual volume of 450 mL. The most appropriate initial management is:

• A Indwelling urethral catheter for life
• B Solifenacin 5 mg daily
• C Mid-urethral sling placement
• D Clean intermittent self-catheterization ✓

Explanation

Diabetic cystopathy causes sensory loss and an atonic, hypotonic bladder, producing overflow incontinence with a large residual volume. Treatment is timed double voiding combined with clean intermittent self-catheterization to empty the bladder and protect renal function. An antimuscarinic would worsen retention, a sling treats stress incontinence and would be harmful here, and a permanent indwelling catheter carries infection risks and is reserved when self-catheterization is impossible.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.