Mixed Urinary Incontinence Patients Research Articles

Single Incision Sling Surgery for Female Stress Urinary Incontinence: A Retrospective Cohort Single-Institution Study.

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI.

Patients with transobturator tape: a retrospective observational study of ten-year follow-up

Stress urinary incontinence (SUI) may result from intrinsic sphincter weakness or urethral hypermobility brought on by weakened muscles in the pelvic floor that sustain the urethra and bladder. The amount of mid-urethral support is increased by the mid-urethral tape's function to serve as an anchored pubo-urethral neo-ligament. This study's objective is to assess the safety and effectiveness of transobturator tape (TOT) for SUI after a 10-year follow-up period. There were 103 patients included in this retrospective observational single-arm research. Only 95 participants were included in the trial since 8 patients were lost to follow-up. Patients who had TOT between 2010 and 2013 were monitored until December 2022. The effectiveness of the tape was assessed at 10 years for both early and late surgical problems in the patients. Those diagnosed with SUI were 52.27 years old on average (standard deviation ±8.48). 24% of patients (n=21) experienced mixed urinary incontinence (MUI), compared to 79.61% (n=82) of patients who had just pure stress incontinence. At 10 years, the success rate in our research was 97.09%. Demand incontinence was healed in 57.14% (n=12) of the 21 MUI patients. 7.69% of de novo urgency was noted (n=7). There were no significant side effects including mesh erosion, bladder and intestine perforation, or vascular hemorrhage. Excellent patient satisfaction was rated in 43% of cases (n=44), good in 54% of cases (n=56), and low in 3% of cases (n=3). At 10 years, TOT for SUI shows an impressive cure rate and excellent effectiveness. When the treatment is carried out by experienced hands, there are no significant difficulties.

Bladder neck incompetence could be an etiology of overactive bladder syndrome in women with stress urinary incontinence after anti-incontinence surgery: insights from transrectal sonography.

To investigate the prevalence of bladder neck incompetence (BNI) and the anatomic differences between different types of urinary incontinence (UI) and overactive bladder (OAB) by transrectal sonography, and to investigate these differences among those with stress UI (SUI) or mixed UI (MUI) who exhibited de novo or persistent OAB symptoms following anti-incontinence surgery. A retrospective analysis was conducted on a total of 184 patients with SUI, MUI, urge UI (UUI), or OAB dry who underwent transrectal ultrasound between 2017 and 2022. The presence of BNI and urethral incompetence assessed by transrectal ultrasound were recorded in all included patients, and recorded preoperatively and postoperatively among patients with SUI and MUI who underwent anti-incontinence surgery. Among the patients, 91%, 84%, 76%, and 71% exhibited BNI in MUI, SUI, UUI, OAB dry group, respectively. Significantly higher rate of patients with BNI were found in MUI than in OAB dry group. Patients with OAB symptoms after anti-incontinence surgery exhibited significantly higher rates of BNI and urethral incompetence than those who did not have postoperative OAB symptoms. Among MUI patients with preoperative BNI, significantly lower rate of postoperative BNI and urethral incompetence was observed in individuals who had improved OAB symptoms after surgery, compared to those without improvement. A higher BNI rate was observed in the MUI group. A significantly higher BNI rate was observed in women with OAB symptoms after anti-incontinence surgery. Patients with MUI had improved OAB symptoms if BNI was successfully corrected after anti-incontinence surgery.

Nine years follow-up after TVT-O; the mesh still available for women suffering from urinary incontinence

ObjectiveThe efficacy of TVT-O is well established in patients with stress urinary incontinence (SUI). The objective of this study was to evaluate the efficacy, safety and patient satisfaction of TVT-O in patients suffering from primary or recurrent SUI or mixed urinary incontinence (MUI). MethodsA single-center follow-up study was conducted. All consecutive women treated by TVT-O between August 2004 and October 2011 were included. Objective treatment success was a negative stress test. Patient satisfaction was assessed by questionnaires. ResultsThe mean time from the surgery to the last follow-up visit was 9 years. One hundred and six patients were included in the final evaluation. Nineteen patients (18%) were previously operated on for urinary incontinence (UI). Ninety patients (85%) were objectively cured; 68 (89%) of the SUI and 22 (73%) of the MUI patients (p = 0.067). Fourteen (74%) of the previously operated patients and 76 (87%) of the patients who underwent first-time TVT-O were objectively cured (p = 0.158). Eighty-six patients (81%) achieved subjective success; 70 (92%) of the SUI and sixteen (53%) of the MUI patients (p<0.001). Eleven women (58%) who had repeat surgery and 75 women (86%) who had primary operation were subjectively cured (p = 0.008). ConclusionsTVT-O is effective in women who suffer from SUI having 90% objective and subjective cure rate 9 years after surgery. There were no major complications, but 16% of the women suffered from groin pain and 37% had urgency symptoms. The results of TVT-O were still good, and it is a therapeutic alternative for different subgroups of UI including recurrent cases.

Factors predicting treatment success in mixed urinary incontinence treated with midurethral sling.

We aimed to investigate success rates and predictive factors for midurethral slings (MUS) in women with mixed urinary incontinence (MUI). Women with MUI (urodynamically diagnosed detrusor overactivity and stress urinary incontinence) treated with MUS between 2013 and 2020 were retrospectively investigated. Prior to MUS, all participants completed bladder diary and questionnaires and underwent a urodynamic study. Six months after surgery, patients were evaluated for lower urinary tract symptoms with pelvic examination, pad test, and the 8-item Overactive Bladder Questionnaire (OAB-V8) and the International Consultation on Incontinence Questionnaire-Short-Form (ICIQ-SF). Success rates after MUS were determined separately according to the predominant component of MUI. In addition, multivariable logistic regression analysis was used to determine the most important independent variables affecting the surgical outcome. There were 117 participants. The overall MUI cure rate was 73.5%, but surgical success in the presence of postoperative urgency was 60.7%. Moreover, MUS success rate was 84.8% in those with preoperative stress-dominant MUI. However, the success rates for equally and urgency-dominant MUI were both 29.4%. Preoperative OAB-V8 score, symptom duration >9.5 years, and preoperative anticholinergic medication were risk factors for persistent urgency and urgency urinary incontinence (UUI) postoperatively (p < .05). In addition, diabetes mellitus (DM) for persistent urgency and voiding frequency (daily) for persistent UUI were predictive factors (p < .05). MUS may be offered to women with stress-dominant MUI. However, postoperative urgency might change a patient's perception of treatment despite successful incontinence treatment. MUS does not appear to be a good option when MUI patients have a high OAB-V8 score, symptom duration >9.5 years, DM, or use of anticholinergic medication preoperatively.

Sequential combined approach in patients with mixed urinary incontinence: surgery followed by posterior tibial nerve stimulation.

The aim of the study was to demonstrate the efficacy of sequential combined treatment with transobturator tape (TOT) followed by posterior tibial nerve stimulation (PTNS) in patients with mixed urinary incontinence (MUI); quality of life and patients' satisfaction was also assessed. Retrospective analysis on women affected by MUI with prevalent Stress Urinary Incontinence (SUI) component. Women, divided in 2 groups, underwent different treatments, TOT vs. TOT+PTNS. Population was assessed by medical history, previous pelvic surgery, clinical exam, urodynamic exams, pelvic ultrasound examination, and questionnaires (The International Consultation on Incontinence Questionnaire Short Form, Overactive Bladder Questionnaire, Health Related Quality of Life) comparing them before and after 12 weeks after treatment. One hundred twelve women were enrolled in the study. The mean age was 57.96±7.34 in the first group (N.=60) and 58.29±6.14 in the second group (N.=52). Peak flow (mL/s) statistically improved after treatment, 22.23±4.29 (TOT) vs. 24.81±5.8 (TOT+PTNS). First voiding desire (mL) improved significantly between the two groups 108.72±19.24 vs. 142.43±19.98. Maximum cystometric capacity (mL) in the TOT group at 12-weeks was 328.76±82.44 vs. TOT+PTNS group of 396.26±91.21. Detrusor pressure at peak flow(cmH2O) showed a greater improvement in TOT+PTNS than TOT alone 14.45±6.10 vs. 11.89±54.49. At 12-week, urinary diary and quality of life improved in terms of urgent urination events, mean number of voids, urge symptoms and nocturia events. The Patient Impression of Global Improvement (PGI-I) after 3 months was better in combined group. Combined and sequential TOT+PTNS is more effective compared to TOT alone in MUI patients with prevalent SUI component.

Adherence to professional society guidelines among women with stress or mixed urinary incontinence.

AimsThe objective of this analysis was to describe longitudinal adherence with recommended urinary incontinence (UI) evaluation and treatment guidelines over a 2‐year period in patients newly diagnosed with stress (SUI) or mixed UI (MUI), and average 2‐year cost associated with initial treatment.MethodsA retrospective claims analysis using the IBM MarketScan database was conducted. Women diagnosed with SUI/MUI between July 1, 2014 and June 30, 2016 were identified using the International Classification of Diseases (ICD) 9 and 10 codes for SUI or MUI. Newly diagnosed SUI/MUI patients who did not have a UI‐related diagnosis for at least 1 year before their index date were assessed.Results103 813 patients with newly diagnosed SUI or MUI were identified. Of those, 96.15% (99 821/103 813) received an initial evaluation in accordance with professional guidelines (e.g., patient history, physical examination, urinalysis). Only 6.8% (5086/74 925) and 7.7% (2229/28 888) of patients with SUI and MUI, respectively, received a first‐line behavioral treatment (e.g., pelvic floor muscle exercises, bladder training), according to guidelines. The 2‐year average UI‐related medical costs associated with guideline adherence for SUI were $5770.93 ± $9454.81 and for MUI, $4416.16 ± $7401.53. Nonadherence was observed in 59.2% (44 382/74 925) of SUI and 64.1% (18 530/28 888) of MUI patients. Two‐year average UI‐related medical costs for the nonadherent group were $8568.00 ± $11 275.52 for SUI and $6986.66 ± $10 765.55 for MUI, significantly more than the adherent group (p < 0.0001).ConclusionThe majority of SUI or MUI patients do not receive a documented behavioral intervention as their first‐line treatment, which is a recommendation by professional society guidelines. This was found to affect the cost burden for payers; those that were nonadherent had significantly higher costs 2‐year postindex.

MP27-17 COULD DETRUSOR OVERACTIVITY PREDICT THE USE OF ANTIMUSCARINICS AFTER MID-URETHRAL SLING IN WOMEN WITH MIXED URINARY INCONTINENCE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2018MP27-17 COULD DETRUSOR OVERACTIVITY PREDICT THE USE OF ANTIMUSCARINICS AFTER MID-URETHRAL SLING IN WOMEN WITH MIXED URINARY INCONTINENCE? Yun-Chu Chang, Yu-Hua Fan, and Alex T.L. Lin Yun-Chu ChangYun-Chu Chang More articles by this author , Yu-Hua FanYu-Hua Fan More articles by this author , and Alex T.L. LinAlex T.L. Lin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.896AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with mixed urinary incontinence (MUI) suffer from components of both stress urinary incontinence (SUI) and overactive bladder (OAB). Many studies have shown that surgical management of SUI with a mid-urethral sling (MUS) may help OAB symptoms. It is important to evaluate the predictive factors of change in OAB symptoms after MUS in MUI patients. We conduct this study to evaluate whether detrusor overactivity (DO) could predict the change in OAB symptoms after MUS in women with MUI. METHODS We retrospectively recruited female patients with MUI treated with retropubic synthetic MUS between 2008 and 2015. All patients completed the questionnaires of Overactive Bladder Symptoms Score (OABSS) and Urogenital Distress Inventory (UDI-6) preoperatively. MUI was defined as clinical SUI with positive response to urgency or urge incontinence subscale of OABSS, or urge incontinence subscale of UDI-6. All patients underwent videourodynamic study prior to MUS. The primary outcome was the postoperative use of antimuscarinics defined as the prescription of antimuscarinics one month after MUS for more than one month. We evaluated the effects of DO and other potential risk factors for the primary outcome. RESULTS A total of 187 patients were included in the study, with 35 demonstrated with DO and 152 without DO. 26 patients with DO and 110 patients without DO required postoperative antimuscarinics. The mean duration of postoperative antimuscarinics was 6.2 ± 4.1 months. There was no significant difference in postoperative antimiscarinics between patients with and without DO. However, patients with lower detrusor pressure at maximum flow tended to use antimuscarinics after MUS in DO patients. Age, body mass index and the combination of pelvic organ prolapse surgery were similar between patients with and without postoperative antimuscarinics. Urgency and urge incontinence subscores of OABSS were significantly higher in patients with postoperative antimuscarinics than those without. Besides, urgency subscore of UDI-6 was significantly higher in patients requiring postoperative antimuscarinics. CONCLUSIONS DO alone could not predict the use of antimuscarinics after MUS in women with MUI. Nevertheless, DO patients with lower detrusor pressure at maximum flow have the tendency toward using postoperative antimuscarinics. MUI women with more severe baseline urgency and urge incontinence have higher possibility to use antimuscarinics after MUS. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e354 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yun-Chu Chang More articles by this author Yu-Hua Fan More articles by this author Alex T.L. Lin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does urinary incontinence subtypes affect sexual function?

ObjectiveUrinary incontinence (UI) may affect a woman's physical and psychological well-being in different aspects. The aim of this study was to compare the effects of urinary stress incontinence (USI), detrusor overactivity (DO) and mixed urinary incontinence (MUI) on sexual function. Study designOne-hundred and seventy urinary incontinent, sexually active women were included in this cross-sectional study. After urodynamic evaluation, participants were divided into three subgroups as USI (n=61), DO (n=55) and MUI (n=54). Patients were matched according to age, parity and body mass index (BMI), rendering the sample size to 41 patients in each group. Turkish version short form of the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) was filled out by each of the participants. Totally, 52 patients were excluded from the study (47 could not be matched and 5 incomplete questionnaire). Demographic characteristics of the participants, total and three domain scores of PISQ-12 were compared among three UI subgroups. ResultsThe study group was consisted of 38 (32.2%) DO, 41 (34.7%) USI and 39 (33.1%) MUI patients. Demographic characteristics of the patients were similar in three subgroups. Patients with a diagnosis of MUI had significantly lower mean PISQ-12 scores than the ones with USI and DO whereas patients with USI had lower mean PISQ-12 scores than patients with DO. ConclusionAlthough urinary stress incontinence effects sexual function more than detrusor overactivity in terms of PISQ-12 scores, mixed urinary incontinence has the greatest impact on sexual function when compared with urinary stress incontinence and detrusor overactivity.

Are There Risk Factors for Persistent Urge Urinary Incontinence after the Transobturator Tape (TOT) Procedure in Mixed Urinary Incontinence?

PurposeWe wanted to identify factors predicting persistent urge urinary incontinence (UUI) after the transobturator tape (TOT) procedure in patients with mixed urinary incontinence (MUI).Materials and MethodsOf 293 patients who underwent a TOT procedure from May 2007 to August 2010, 175 MUI patients had at least one 6-month follow-up visit. Preoperative evaluations including history taking, physical examination, urinalysis, urine culture, uroflowmetry, postvoid residual (PVR), urodynamic studies (UDS), and symptom questionnaire were performed. After the operation, surgical outcome and patient satisfaction were assessed by symptom questionnaire, uroflowmetry, PVR, and stress test. Statistical analysis was carried out to determine the possible factors influencing persistent UUI after the TOT procedure.ResultsOf 175 patients with MUI, 51 (29.1%) had persistent UUI after the TOT procedure. In a univariate analysis, age (p=0.012) and previous anticholinergic use (p=0.040) were found to be associated with persistent UUI. However, only age (adjusted odds ratio, 3.317; 95% confidence interval, 1.015-12.060; p=0.036) was an independent risk factor in the multivariate analysis.ConclusionsOur findings suggested that women who are older than 65 years may have an increased likelihood of persistent UUI after a TOT procedure. Clinicians should consider the possibility of persistent postoperative UUI in elderly women with mixed incontinence.

Surgical treatment of female stress urinary incontinence with a transobturator tape (Monarc): Short‐term results of a prospective multicenter study

Transobturator tape (TOT) kits approved as medical instruments are still not available in Japan. This study aimed to: (1) assess the outcomes of TOT using Monarc (American Medical Systems; AMS Inc, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI); (2) evaluate possible different surgical outcomes in women with urethral hypermobility (UH) and/or intrinsic urethral deficiency (ISD); and (3) evaluate the possibility of improvement of preoperative urgency and urge urinary incontinence after TOT in mixed urinary incontinence (MUI). Data from 140 women with SUI in a prospective multicenter study were examined at 3-6 months follow-up. 82.1% of the patients were cured and 10.7% showed improvement. The surgical outcome was significantly better in UH than in UH combined with ISD or ISD. In 44 MUI patients, 79.6% were cured and 15.9% showed improvement. Urgency improved in about 75% of patients after TOT. TOT is effective for both SUI and MUI, with urgency improving.

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

Our purpose was to determine if women with mixed urinary incontinence (MUI) and urodynamic detrusor overactivity (DO) have less improvement in urinary symptoms after pubovaginal sling surgery (PVS), compared to MUI without DO. Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H20 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6) questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59). Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30) for Group A and B. Mean changes in total UDI-6 after PVS were - 8.0 and - 10.2 (p = 0.030), respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83). There were no differences between the groups when comparing demographic, urodynamic, or operative data. MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.

Validez del cuestionario King’s Health para la evaluación de la calidad de vida en pacientes con incontinencia urinaria

To assess the validity of the Spanish version of the King's Health Questionnaire (KHQ) for measuring the quality of life of women with different types of urinary incontinence. 77 women with urinary stress incontinence (USI), 51 with urge incontinence (UUI) and 34 with mixed urinary incontinence (MUI) were consecutively recruited. Subjects were diagnosed using urodynamic tests. Patients completed the KHQ and SF-36 questionnaires on inclusion in the study, after 15 days, and again after one month. There were no significant differences in socio-demographic and QOL characteristics between different UI groups. UUI and MUI patients had greater urinary frequency and urge than USI patients, and USI and MUI patients had a greater number of leakage episodes than UUI patients. Correlations between dimensions on the KHQ and the SF-36 were moderate to strong. Women with greater urinary frequency, greater urgency, more incontinence episodes during the week and who used pads and nappies perceived a worse quality of life. Changes in these variables correlated with changes in HRQOL. The internal consistency of dimensions was good (0.65-0.92) as was test-retest reliability (0.68-0.88). Dimensions most sensitive to change after one month of treatment were impact of UI, seriousness of UI, and the symptoms scale (effect size greater than 0.6). The KHQ is a valid instrument for measuring the quality of life of patients with different types of UI. Improvements in urinary frequency, urinary urgency, number of leakage episodes, and changes in the type of protective material produces an increase in HRQOL.