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Overactive bladder syndrome — MSRA MCQ

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HardLUTSOveractive bladder syndromeMSRA

A 72-year-old woman has urgency urinary incontinence, daytime frequency and nocturia. A 3-day bladder diary shows frequent small-volume voids associated with urgency; nocturnal urine volume is 28% of her 24-hour output. Urine dipstick is negative and post-void residual volume is 25 mL. She has no pelvic organ prolapse, dysuria, haematuria, heart failure or peripheral oedema. Her symptoms remain troublesome after a supervised 6-week bladder-training programme. She has untreated narrow-angle glaucoma. Her blood pressure, confirmed using appropriate technique at 2 recent reviews, is 184/112 mmHg and 182/110 mmHg. eGFR is 62 mL/min/1.73 m². Which pharmacological treatment is most appropriate for her bladder symptoms at this stage?

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Correct answer: A — Commence vibegron 75 mg once daily

This is overactive bladder syndrome: urgency urinary incontinence with frequency, a supportive bladder diary, no urinary infection, and a low residual volume. She has not responded sufficiently to bladder training, so drug treatment is appropriate. Vibegron 75 mg once daily is the best option. NICE recommends vibegron for adults with overactive bladder when antimuscarinics are unsuitable, ineffective or not tolerated. Antimuscarinics are unsuitable here because untreated narrow-angle glaucoma is a contraindication to solifenacin and is a class-relevant safety concern; using a transdermal formulation of oxybutynin does not remove its antimuscarinic effect. Her low residual volume and absence of obstructive symptoms make clinically significant outlet obstruction unlikely, although she should be advised to report impaired emptying or retention. Mirabegron is contraindicated in severe uncontrolled hypertension, defined in its SmPC as systolic pressure of at least 180 mmHg and/or diastolic pressure of at least 110 mmHg. Lowering the starting dose does not overcome that contraindication. Desmopressin is not appropriate because the diary excludes nocturnal polyuria, and her age and uncontrolled hypertension further increase prescribing concern. Her severe hypertension also requires prompt separate assessment and management.

Reference: NICE TA999: Vibegron for treating symptoms of overactive bladder syndrome — Recommendations (4 September 2024) — https://www.nice.org.uk/guidance/ta999/chapter/1-Recommendations?UNLID=486013771202591871532 Mirabegron Astellas 50 mg prolonged-release tablets — Summary of Product Characteristics (12 January 2026) — https://www.medicines.org.uk/emc/product/7540/smpc Obgemsa 75 mg film-coated tablets — Summary of Product Characteristics (14 March 2025) — https://www.medicines.org.uk/emc/product/15962/smpc