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Overactive bladder syndrome — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardLUTSOveractive bladder syndromeMSRA

A 72-year-old woman presents with 8 months of urinary urgency, daytime frequency and urge urinary incontinence. A 3-day bladder diary shows 13 small-volume voids daily, urgency preceding leakage, and nocturnal urine volume of 22% of her 24-hour output. Urine culture is negative. She has no stress incontinence, dysuria, visible haematuria, pelvic organ prolapse, voiding difficulty or constipation. Post-void residual volume is 35 mL. She has completed a supervised 6-week bladder-training programme and reduced caffeine intake, but remains significantly troubled by symptoms. She has untreated narrow-angle glaucoma and is awaiting laser peripheral iridotomy. Her blood pressure is 184/112 mmHg on two appropriately measured readings; she has no symptoms or signs of acute end-organ damage, and urgent assessment of her hypertension has been arranged. eGFR is 58 mL/min/1.73 m² and liver function tests are normal. What is the most appropriate pharmacological treatment for her overactive bladder symptoms?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start vibegron 75 mg once daily

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · B = shown as D

This is overactive bladder (OAB): urgency-associated leakage with frequent small voids, a supportive bladder diary, negative culture and a low post-void residual volume. Conservative treatment has been insufficient, so pharmacotherapy is appropriate. Antimuscarinics would ordinarily be first-line drug treatment, but solifenacin is contraindicated in narrow-angle glaucoma; this class effect makes solifenacin, tolterodine and oxybutynin inappropriate while her glaucoma remains untreated. Mirabegron is contraindicated in severe uncontrolled hypertension, defined in its SmPC as systolic blood pressure of at least 180 mmHg and/or diastolic pressure of at least 110 mmHg. Reducing the dose to 25 mg does not remove that contraindication. Vibegron is a NICE-recommended beta-3-adrenoceptor agonist option when antimuscarinics are unsuitable. Its licensed adult dose is 75 mg once daily. Her low residual volume and absence of voiding symptoms make clinically significant bladder outlet obstruction unlikely, although she should still be advised to report difficulty voiding or symptoms of retention. Her severe hypertension requires urgent parallel assessment and treatment, but is not a listed contraindication to vibegron. A, D and E are antimuscarinics contraindicated by narrow-angle glaucoma. B is contraindicated by her measured blood pressure. C is therefore the single best pharmacological option.

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 Obgemsa 75 mg film-coated tablets — Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/15962/smpc Mirabegron Astellas prolonged-release tablets — Summary of Product Characteristics (5 January 2026) — https://www.medicines.org.uk/emc/product/7540/smpc