Name two first-line pharmacologic treatments for urge urinary incontinence.

• A. Antimuscarinics (e.g., oxybutynin) and beta-3 adrenergic agonists (e.g., mirabegron)
• B. Beta-blockers and diuretics
• C. Alpha blockers and PDE-5 inhibitors
• D. Anticholinergics and SNRI

Answer: (A)

Two first-line pharmacologic options for urge urinary incontinence target detrusor overactivity, the hallmark of overactive bladder. Antimuscarinics, such as oxybutynin, block muscarinic receptors on the detrusor muscle (primarily M3), which reduces involuntary contractions during filling and increases bladder capacity. Beta-3 adrenergic agonists, like mirabegron, activate beta-3 receptors on the detrusor to promote relaxation during the storage phase, also increasing capacity and decreasing urgency. Together, these categories address the abnormal detrusor activity that drives urgency and leakage and are considered initial pharmacologic therapy because of their effectiveness and tolerable safety profiles.

The other options don’t fit as first-line treatments for urge incontinence: beta-blockers and diuretics don’t influence detrusor overactivity; alpha blockers and PDE-5 inhibitors are more related to obstruction or specific male lower urinary tract symptoms; and while anticholinergics are part of this approach, pairing an anticholinergic with an SNRI isn’t a standard first-line strategy for urge incontinence.