What is the first-line medical therapy for overflow incontinence?

• A. Finasteride
• B. Tolterodine
• C. Oxybutynin
• D. Tamsulosin (A-blocker)

Answer: (D)

Overflow incontinence in men is typically due to bladder outlet obstruction from benign prostatic hyperplasia, leading to poor emptying and leakage when the bladder overfills. The key therapeutic aim is to relieve that obstruction to improve flow and reduce residual urine. An alpha-blocker such as tamsulosin is used first because it relaxes smooth muscle at the bladder neck and prostatic urethra, lowering outlet resistance and allowing better urine passage. This helps restore more complete bladder emptying and reduces leakage from overfilling.

Finasteride lowers prostate volume more gradually and is not an immediate or universal first-line choice for overflow. Antimuscarinic drugs like tolterodine and oxybutynin target detrusor overactivity and can worsen retention, making them inappropriate as first-line in overflow scenarios.