This meta-analysis compared mirabegron and vibegron efficacy/safety in female overactive bladder (OAB) patients, adhering to PRISMA guidelines (PROSPERO CRD42024587945). Pooling data from 3 RCTs (n=371), vibegron showed superior urgency urinary incontinence relief versus mirabegron (p=0.02), while demonstrating comparable OAB symptom scores, urgency episodes, quality of life, and voided volumes. Safety profiles were similar for total adverse events, constipation, post-void residuals, and dizziness. Both medications exhibit comparable overall efficacy and safety, though vibegron may offer specific advantages in managing incontinence symptoms.