Treatment of Urgent Urinary Incontinence
Efficacy
- The American College of Physicians recommends that both solifenacin and mirabegron are effective for reducing episodes of urgent urinary incontinence, with a moderate effect size for achieving continence 1, 2
- Pharmacological therapies are also effective for managing urgent urinary incontinence when bladder training has failed, with a moderate strength of evidence 1, 3
- The combination of solifenacin 5 mg and mirabegron 50 mg offers superior efficacy to monotherapies, with additive effects on reducing incontinence episodes, micturitions, and urgency 4, 5
Adverse Effect Profile
- Solifenacin, an antimuscarinic, has typical adverse effects including dry mouth, constipation, and blurred vision, with a number needed to harm (NNH) of 78 1, 2, 6
- Mirabegron, a β3-adrenergic agonist, has a different adverse effect profile, with less anticholinergic effects, and typical adverse effects including rhinopharyngitis and gastrointestinal disorders 1, 2, 6
Treatment Algorithm
- The American Urological Association recommends bladder training as the first-line treatment for urgent urinary incontinence, with a strong recommendation and moderate-quality evidence 1, 3
- For patients who fail bladder training, pharmacological treatment is recommended, with solifenacin or mirabegron as options, based on patient preferences and adverse effect profiles 1, 2, 3, 6
- Combination therapy with solifenacin 5 mg and mirabegron 50 mg may be considered for patients refractory to monotherapy, with a moderate strength of evidence 4, 7
Important Considerations
- The choice of pharmacological treatment should be based on tolerance, adverse effect profile, ease of use, and cost of the medication, with a moderate strength of evidence 1, 3
- Solifenacin 5 mg is associated with the lowest risk of treatment discontinuation among antimuscarinics, with a moderate strength of evidence 1, 2
- Mirabegron has a different adverse effect profile, with less anticholinergic effects, and may be preferred for patients concerned about anticholinergic adverse effects, with a moderate strength of evidence 2, 6