Abstract
Introduction and hypothesis
Mixed urinary incontinence (MUI) is defined as symptomatic complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing. The paucity of research, especially on the surgical management of MUI, limits its best management.
Methods
This is a retrospective study to determine the outcomes of mixed urinary incontinence after mid-urethral sling surgery with two groups, urodynamic stress incontinence (USI) with urgency and urodynamic mixed urinary incontinence (MUI-UD; USI and detrusor overactivity [DO]).
Results
Ninety women (USI + urgency group) with preoperative USI and urgency and no demonstrable DO/DOI attained an objective cure of 82.2%, whereas the remaining 67 (MUI-UD group) women with both USI and DO/DOI were reported to have an objective cure of only 55.2%. Subjective cures were 81.1% and 53.7% respectively. The type of incontinence surgery does not affect postoperative outcomes in either of the groups. Demographic factors identified to have a significant negative effect on cure rates were postmenopausal status (p = 0.005), prior hysterectomy (p = 0.028), pre-operative smaller blafdder capacity (p = 0.001), and a larger volume of pre-operative pad test (p = 0.028). A lower mid-urethral closure pressure (MUCP) was significant with post-operative failure of treatment with MUI-UD group (68.8 ± 36.2 cmH2O vs 51.9 ± 24.7 cmH2O; p = 0.033).
Conclusions
Although there is evidence for a good cure of the stress component of MUI, urodynamic investigation with its findings prior to management of MUI could have greater implications for selective patient centered counseling. Presence of DO or DOI on urodynamics resulted in poorer objective and subjective outcomes.
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References
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.
Khullar V, Cardozo L, Dmochowski R. Mixed incontinence: current evidence and future perspectives. Neurourol Urodyn. 2010;29(4):618–22.
Wu SP, Lo TS, Pue LB, et al. Outcome after conservative management for mixed urinary incontinence. J Obstet Gynaecol Res. 2015;41(2):269–76.
Jain P, Jirschele K, Botros SM, Latthe PM. Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2011;22(8):923–32.
Minassian VA, Yan XS, Pitcavage J, Stewart WF. Mixed incontinence masked as stress induced urgency urinary incontinence. J Urol. 2016;196(4):1190–5.
Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.
Lo TS, Chua S, Kao CC, Uy-Patrimonio MC, Ibrahim R, Tan YL. Five-year outcome of MiniArc single-incision sling used in the treatment of primary urodynamic stress incontinence. J Minim Invasive Gynecol. 2018;25:116–23.
Lo TS, Shailaja N, Chua S, Tseng LH, Kao CC, Wu MP. Evaluation of clinical outcome and risk factors for failure of single-incision midurethral short tape procedure (Solyx tape) for stress urinary incontinence. J Minim Invasive Gynecol. 2018;26:688–94. https://doi.org/10.1016/j.jmig.2018.07.013.
Lo TS, Jaili SB, Tan YL, Wu PY. A 5-year follow-up study on Monarc transobturator tape for surgical treatment of primary stress urinary incontinence. Int Urogynecol J. 2016;27:1653–9.
Lo TS, Wang AC, Horng SG, Liang CC, Soong YK. Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT). Acta Obstet Gynecol Scand. 2001;80:65–70.
Su TH, Lau HH. Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire. J Sex Med. 2010;7(12):3940–5.
Kammerer-Doak D, Rizk DE, Sorinola O, Agur W, Ismail S, Bazi T. Mixed urinary incontinence: International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2014;25(10):1303–12.
Balachandran A, Duckett J. Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling? Int Urogynecol J. 2016;27(12):1913–8.
Salinas-Casado J, Mendez-Rubio S, Pesquera-Ortega L, et al. Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings. Arch Esp Urol. 2016;69(4):172–7.
Gleason JL, Parden AM, Jauk V, Ballard A, Sung V, Richter HE. Outcomes of midurethral sling procedures in women with mixed urinary incontinence. Int Urogynecol J. 2015;26(5):715–20.
Gamble TL, Botros SM, Beaumont JL, et al. Predictors of persistent detrusor overactivity after transvaginal sling procedures. Am J Obstet Gynecol. 2008;199(6):696.e1-7.
Paick JS, Oh SJ, Kim SW, Ku JH. Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):123–9.
Petros PE. Mixed urinary incontinence—time to uncouple urgency from stress? Int Urogynecol J. 2011;22(8):919–21.
Brubaker L, Stoddard A, Richter H, et al. Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009;28(4):268–73.
Natale F, Illiano E, La Penna C, Balsamo R, Costantini E. Mixed urinary incontinence: a prospective study on the effect of trans-obturator mid-urethral sling. Eur J Obstet Gynecol Reprod Biol. 2018;221:64–9.
Engen M, Svenningsen R, Schiotz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn. 2018;37(8):2578–85.
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TSL: protocol/project development, data collection, data analysis, manuscript editing; YLT: data analysis, manuscript writing, manuscript editing; LBP: data analysis, manuscript editing; SC: data analysis, manuscript editing; MPW: data analysis, manuscript editing; WCH: data collection, data analysis.
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Lo, TS., Tan, Y.L., Pue, L.B. et al. Outcomes of urodynamic mixed urinary incontinence and urodynamic stress incontinence with urgency after mid-urethral sling surgery. Int Urogynecol J 31, 1949–1957 (2020). https://doi.org/10.1007/s00192-019-04213-3
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DOI: https://doi.org/10.1007/s00192-019-04213-3