Incontinence: The Daily PANCE Blueprint
A 48-year-old woman presents with ongoing urinary urgency and leakage episodes several times per week despite performing regular pelvic floor exercises over the past 2 months. She has no stress incontinence symptoms. Post-void residual is <50 mL. Which of the following is the most appropriate next step in management?
A. Oxybutynin ER 5 mg daily
B. Solifenacin 5 mg daily
C. Mirabegron 25 mg daily
D. Midurethral sling surgery
E. Fluid restriction
Answer and topic summary
The answer is C) Mirabegron 25 mg daily
This patient with urge urinary incontinence has already trialed pelvic floor muscle training without sufficient improvement. Guidelines recommend a trial of antimuscarinic medication or beta-3 agonist next. Mirabegron is preferred over antimuscarinics like oxybutynin or solifenacin due to its lower side effect profile. Mirabegron is available in 25 and 50 mg extended-release doses. Mirabegron monotherapy is started at 25 mg daily. Although up to eight weeks may be required for full efficacy, the dose can be increased to 50 mg daily as quickly as four weeks from initiation if patients are tolerating the drug but have inadequate symptom control. The typical time frame to assess medication impact is four to six weeks. Patients with severe renal or moderate hepatic impairment should not receive more than 25 mg daily. Midurethral sling surgery is for stress incontinence. Fluid restriction is not routinely needed.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Genitourinary ⇒ ⇒
Also covered as part of the Women's Health EOR and Emergency Medicine EOR topic lists
