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Urgency urinary incontinence affects nearly one in five older U.S. women. First-line treatment often involves oral anticholinergic therapy, and onabotulinumtoxinA (Botox) injections are sometimes used for refractory cases (JW Gen Med Jan 20 2011). In a double-blind, double-placebo–controlled trial, federally funded investigators randomized women with urgency incontinence to the oral anticholinergic solifenacin (Vesicare) or a single cystoscopically delivered 100-U injection of onabotulinumtoxinA to the detrusor muscle. The initial 5-mg daily dose of solifenacin could be doubled and then changed to 60-mg trospium XR (Sanctura) as needed. Mean daily urgency incontinence episodes were assessed for 6 months, when oral study medications were sto…