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About 25% of women older than 75 report having urge urinary incontinence (UUI; sudden, uncontrollable need to urinate). First-line treatments include lifestyle modification, bladder training, and vaginal estrogen if vaginal atrophy is also present. Second-line treatments consist of antimuscarinic agents (e.g., oxybutynin) or a β3 agonist (mirabegron). For severe refractory UUI, third-line approaches include injection of onabotulinumtoxinA (OBA) into the bladder wall and implantation of a sacral neuromodulation unit. To test the clinical efficacy of these two treatments, NIH investigators randomized 386 women (mean age, 63) with UUI (mean daily episodes, 6) to a single 200-U injection of OBA or permanent implantation of a sacral neuromodulat…