Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment for detrusor instability?

1. Bladder drill training

2. Anticholinergic medication

3. Catheterization

4. Surgery

The correct answer is: Bladder drill training

Detrusor instability, often referred to as overactive bladder, involves involuntary contractions of the bladder muscle, leading to a frequent and urgent need to urinate. The first-line treatment in managing this condition is typically non-pharmacological and involves bladder training techniques. Bladder drill training aims to help patients increase their bladder capacity and control the urge to urinate. This method encourages the gradual extension of the intervals between voiding, thereby training the bladder to hold more urine and reducing the urgency and frequency of bathroom trips. Patients usually start by trying to lengthen the time between voids by using scheduled bathroom visits, focusing on pelvic floor exercises, and practicing relaxation techniques. This approach is particularly beneficial as it instills long-term behavioral changes that empower patients to manage their symptoms effectively without relying solely on medications or invasive treatments. Using medications, such as anticholinergics, may be considered if conservative measures like bladder training do not provide adequate relief; however, the initial recommendation typically emphasizes non-drug strategies first. In summary, bladder drill training serves as an essential first-line intervention for detrusor instability due to its focus on behavioral modification and symptom management, laying a strong foundation for further treatment if necessary.