The management of mixed urinary incontinence in women

Abstract

Mixed urinary incontinence is a common diagnosis among women with urinary leakage and is often present in women who are unable to characterize their incontinence. Research and optimized clinical treatment of these patients is limited by the challenges in objectively defining and stratifying this population. The evaluation of these patients should follow the same general principles as any assessment of any women with incontinence; however, it is essential to define whether urge or stress incontinence is the predominant symptom. Urodynamics (UDS) may be helpful in this regard and may help predict surgical outcomes. Behavioural therapy, weight loss, and pelvic floor muscle therapy are usually appropriate initial management strategies. In postmenopausal women, vaginal estrogen can be considered, and in women with equal parts stress and urge incontinence or urge-predominant mixed incontinence, a trial of anticholinergics or beta-3 agonists is appropriate. In women with stress-predominant or equal parts stress and urge incontinence, stress incontinence surgery can be considered, with the caveat that outcomes are generally worse among women with more severe levels of urgency, success rates may not be as durable, and a significant proportion of women may need additional medical therapy.

Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery vs Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence

“…Guidelines and recommendations for mixed urinary incontinence treatment caution that surgery could worsen the urgency component. 5,6,8 Observational data supporting that midurethral sling surgery remains effective for treating the stress component exists. 9 However, limited studies have evaluated approaches to improve urgency incontinence outcomes after midurethral sling among women with mixed incontinence.…”

Role of Transobturator Tape in the Treatment of Mixed Urinary Incontinence in Women

“…7 Non-surgical treatment is considered as the first-line treatment and includes weight loss, behaviour modification, pelvic floor muscle training, reduced fluid intake, caffeine moderation, biofeedback, anti-incontinence devices, and pharmacological treatment. 2,7,8 While, surgical treatment is an option for women with stress-predominant MUI or with equal components of SUI and UUI, and not responding to nonsurgical interventions. These includes urethral bulking agents, retropubic suspensions, bladder neck slings, or midurethral slings.…”

“…These includes urethral bulking agents, retropubic suspensions, bladder neck slings, or midurethral slings. 2,8 Among these surgical methods, midurethral sling (MUS) procedures such as transobturator tape (TOT) and tension-free vaginal tape (TVT) are most widely used. 2 Some studies have reported that TOT is more promising to result in total resolution of MUI, due to its less obstructive nature.…”

Pelvic floor rehabilitation in the treatment of mixed urinary incontinence among women

“…It is characterized by a combination of stress and urge symptoms in the same patient. It has a major effect on a woman’s quality of life (QOL) [ 1 , 2 ].…”