What is the role of surgery for pure urge incontinence?

• A. Surgery is a primary option for most cases.
• B. Surgery is not a primary option; neuromodulation or botulinum toxin used for refractory cases.
• C. Surgery cures all cases.
• D. Urge incontinence is never treated with drugs.

Answer: (B)

Surgery is not a primary option for urge incontinence; the usual approach starts with non-surgical strategies and medications that reduce detrusor overactivity. When these fail to provide adequate control, the focus shifts to less invasive interventions that help the bladder nerve signals or the detrusor muscle itself. Sacral neuromodulation modulates the neural pathways controlling the bladder and can significantly lessen urgency and leakage. Intradetrusor injections of botulinum toxin A relax the detrusor, decreasing involuntary contractions. These options are reserved for refractory cases and avoid more extensive bladder surgeries. They’re not cures for everyone and carry specific risks, so they’re chosen after medical therapy has proven insufficient. Choices suggesting surgery as the primary option, or that it cures all cases, or that drugs are never used, don’t fit because they skip the evidence-based stepwise approach that starts with medical and neuromodulatory strategies before considering surgical remedies.