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Overactive bladder follow-up — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareOveractive bladder follow-upUSMLE Step 3

A 53-year-old woman has recurrent urinary urgency and leakage on the way to the bathroom. Urinalysis is normal, postvoid residual is 30 mL, pelvic exam shows no prolapse, and cough stress test is negative. She has tried bladder training for 8 weeks with partial improvement. Which of the following is the most appropriate next step in management?

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Correct answer: A — Add an antimuscarinic or beta-3 agonist after reviewing contraindications

Urgency incontinence with normal urinalysis and low postvoid residual is overactive bladder. After behavioral therapy, antimuscarinic or beta-3 agonist therapy is appropriate if contraindications and adverse effects are reviewed.

Reference: American Urological Association Overactive Bladder Guideline