You have been treating an older female patient for urge inco…

You have been treating an older female patient for urge incontinence by addressing reversible risk factors and teaching her to use urge suppression. While her urgency symptoms are reduced, she still reports frequent small voids and great difficulty trying to “get the urine out” even when she strains. She has no prolapse. You decide to refer her to the urologist because you suspect which of the following?