Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram

Abstract

OBJECTIVE To evaluate the outcome of surgery for stress urinary incontinence (SUI) in patients presenting with a combination of stress and sensory urge UI. PATIENTS AND METHODS The study comprised 75 women presenting with mixed incontinence; the most important inclusion criterion was a negative cystometrogram for detrusor overactivity. Based on random selection, a third of the patients received a 6‐month course of anticholinergic treatment (group 1) and 50 (group 2) had surgery for SUI. The surgical procedure depended on the Valsalva leak‐point pressure (VLPP); those with a VLPP of ≥ 90 cmH2O underwent Burch retropubic bladder neck suspension (group 2a, 24 patients) while 26 (group 2b) with a VLPP of < 90 cmH2O had pubovaginal sling (PVS) surgery. A further group of 20 patients with pure SUI (no urge UI) underwent surgery (PVS in 12 and Burch in eight) as a control group (group 3). After at least 6 months of follow‐up (mean 9.3, sd 1.7), 68 patients were evaluable; they were assessed subjectively and objectively for dryness, and by a urodynamic evaluation and quantitative assessment using the SEAPI scoring system. RESULTS In group 1 none of the patients became completely dry; there was persistent stress with and without urge UI in nine (43%) and 12 (57%) of the available 21 patients, respectively. Only three of those who had persistent SUI with no urge in the whole study group were satisfied and chose to continue anticholinergic therapy despite SUI. In this group the mean (sd) improvement in the subjective and objective SEAPI score was 3.4 (1.0) and 2.3 (3.8), respectively. In group 2a, 20 of the available 23 patients (87%) became completely dry (both stress and urge continent). The mean improvement in the SEAPI scores was 7.8 (0.9) and 7.8 (1.3), respectively. In group 2b, 20 of the 24 patients (83%) became completely dry, with mean improvements in SEAPI scores of 8.2 (0.4) and 7.9 (0.3), respectively. The improvement was statistically significant after surgery, vs anticholinergic therapy, for all variables (P < 0.05). The incidence of persistent urge UI was highest in group 1 (43%), being 13% in group 2 (13% and 12% in 2a and b, respectively). In group 3 there was de novo urge UI in four of the 20 patients, and not significantly different from that in group 2. CONCLUSION Most patients with mixed stress and urge UI and a normal cystometrogram were cured of both symptoms by surgery. The incidence of residual urge in such patients was no higher than that of de novo urge after surgery in patients with genuine SUI.

Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling?

“…However, surgical cure rates for the MUI patient are highly variable and range from 60 -97% across several different surgical techniques including retropubic suspensions (4,5), pubovaginal slings (PVS) (6,7), and tension free procedures (8). Currently, it is not fully known if pre-operative urodynamic data can be used to stratify surgical risk for MUI patients undergoing incontinence surgery.…”

Mixed incontinence: Do we have the urge to improve the stress?

“…Women with no DO on UDS show MUI cure rates of 72% to 87% after colposuspension, use of bladder neck sling, or TVT [9,11,43], approaching cure rates seen for women with pure SUI. In their study comparing DO resolution after use of bladder neck slings and TVT, Botros et al [36] found that preoperative DO and sling type (bladder neck) were the most signifi cant risk factors for postoperative DO.…”

Overactive Bladder and Mixed Incontinence

“…At 6-month follow-up, 87% of the women with MUI who underwent Burch were dry, which was not significantly different from the 83% of patients undergoing PVS. Persistent urge incontinence also was similar between the two groups at 13% and 12%, respectively, which was not significantly different from the rate of de novo urge incontinence (20%) in the control group [47]. Several retrospective studies have looked at the efficacy of different surgical procedures in treating MUI.…”