Abstract : The aim of this study was to evaluate and compare the efficacy and safety of three third-line treatment modalities for urgency urinary incontinence (UUI) refractory to pharmacotherapy: sacral neuromodulation (SNM), implantable tibial nerve neuromodulation (iTNM), and intradetrusor injection of botulinum toxin type. The purpose of this literature review is to summarize the current state of knowledge regarding available third-line treatments for urgent urinary incontinence. A literature review of studies published between 2017 and 2026 was conducted, including randomized controlled trials, systematic reviews, and meta-analyses. The primary outcomes assessed were reduction in incontinence episodes, urinary frequency, quality of life, and incidence of adverse events. All three treatment modalities demonstrated significant efficacy in reducing UUI symptoms. Toxin botulin showed the highest short-term effectiveness; however, it was associated with a higher risk of adverse events, particularly urinary retention and urinary tract infections. SNM provided a durable and stable therapeutic effect, although it requires a more invasive procedure. Implantable tibial nerve neuromodulation was associated with a favorable safety profile and lower invasiveness, but its efficacy may be slightly lower and long-term data remain limited. SNM, implantable tibial nerve neuromodulation, and BoNT-A are all effective third-line treatment options for refractory UUI. Treatment selection should be individualized based on efficacy, safety profile, and patient preferences.