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Mixed urinary incontinence: international urogynecological association research and development committee opinion

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Abstract

Background and aim

The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI.

Methods

A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI.

Results

This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations.

Conclusions

The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.

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Abbreviations

IDO:

idiopathic detrusor overactivity

IES:

Intravaginal electrical stimulation

QOL:

quality of life

MUI:

mixed urinary incontinence

MUCP:

maximum urethral closure pressure

OAB:

overactive bladder

PFMT:

pelvic floor muscle training

POP:

pelvic organ prolapse

PVR:

post-void residual

RCT:

randomized controlled trial

SNRI:

serotonin norepinephrine re-uptake inhibitor

SUI:

stress urinary incontinence

TVT:

tension free vaginal tape

UUI:

urgency urinary incontinence

UI:

urinary incontinence

USI:

urodynamic stress incontinence

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Disclaimer

This Committee Opinion was developed by the IUGA R&D Committee. The information is designed to aid practitioners in making decisions about appropriate urogynecological care and should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources and limitations unique to the institution or type of practice.

Conflicts of interest

Dorothy Kammerer-Doak, MD: NONE. Diaa E.E. Rizk: NONE. Olanrewaju Sorinola: NONE. Agur Wael: NONE. Sharif Ismail: NONE. Tony Bazi: Accepted Research funding and Honororia from Novo Nordisk, not related to the writing of this manuscript.

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Summary

This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations.

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Kammerer-Doak, D., Rizk, D.E.E., Sorinola, O. et al. Mixed urinary incontinence: international urogynecological association research and development committee opinion. Int Urogynecol J 25, 1303–1312 (2014). https://doi.org/10.1007/s00192-014-2485-8

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