Mixed Urinary Incontinence Symptoms Research Articles

Compatibility of the urodynamic findings and mixed urinary incontinence symptoms

Introduction: Mixed urinary incontinence (MUI) is one of the most common problems of middle-aged women besides pelvic organ prolapses (POPs), and associated urinary symptoms are common disorders among older women whose treatment is necessary for the improvement of quality of life. This study aimed to evaluate the agreement between the symptoms of patients with MUI and urodynamic findings. Methods: This analytic cross-sectional study was conducted on 170 MUI patients who underwent urodynamic evaluation for confirmation of the presumptive diagnosis. Findings comprise patients with "voiding phase symptoms", "detrusor overactivity" (DO), "bladder hypersensitivity", and "stress urinary incontinence" (SUI). The Kappa coefficient was used to evaluate the agreement between the symptoms and urodynamic findings. Sensitivity, specificity, and agreement of symptoms with corresponding urodynamic findings were determined. Univariate logistic regression was used to estimate the predictive value of clinical history compared to urodynamic findings. Results: According to the results, the mean (SD) age of women was 51.87 (11.20). The mean bladder capacity was 339.6 (134.24), and post-void residual was 35.46 (43.89) ml. We determined a sensitivity of 75%, a specificity of 78.3%, a positive predictive value (PPV) of 86.3%, and a 63.2% negative predictive value (NPV) for SUI symptoms. According to the chi-square test results and Cohen Kappa values, there was no agreement between the symptoms of patients with MUI and bladder hypersensitivity, DO, and SUI. The only agreement was observed between the urinary frequency and voiding phase symptoms (Cohen kappa: 0.124; P value=0.003). Conclusion: There was no agreement between urodynamic findings and MUI symptoms except for urinary frequency and voiding phase symptoms. Since no comprehensive study has been conducted on the correlation between the symptoms of patients with MUI and urodynamic findings in our setting, the necessity to conduct large clinical studies is recommended.

Dropped abdominal pressure at void in women.

"Dropped pabd at void" occurs when pabd decreases below the previous resting pressure during voiding time. We sought clinical factors associated with this phenomenon and evaluated whether its correction modifies the urodynamic diagnosis. Retrospective cross-sectional study of non-neurological consecutive symptomatic women. The following definitions were used: "dropped pabd at void": decrease in pabd at Qmax ≥ 5 cmH2O; bladder outflow obstruction (BOO) (pdetQmax ≥ 25 cmH2O + Qmax ≤ 12 ml/s and female BOO index (pdetQmax - 2.2*Qmax) > 18; "low detrusor contraction strength": PIP1 (pdetQmax + Qmax) < 30. In patients with "dropped pabd at void", pdetQmax was corrected. A total of 360 women were analyzed. Ninety-five percent of the women had a variation in pabd at Qmax between -13 and 53 cmH2O. "Dropped pabd at void"was found in 100 women (27.8%). History of stress urinary incontinence (SUI) surgery was significantly higher (p = 0.016) and symptoms of mixed urinary incontinence were significantly lower (p = 0.030) in patients with "dropped pabd at void". On multivariate analysis only the history of SUI surgery maintained its significance (OR = 1.787 [95% CI: 1.058, 3.017], p = 0.030). When correcting pdetQmax in women with "dropped pabd at void", 2 or 5 patients lost BOO diagnosis (depending on how it was diagnosed) and 7 patients gained a "low detrusor contraction strength"diagnosis. Approximately one-quarter of women had "dropped pabd at void", which was associated with a history of SUI surgery. Correction of pdetQmax would lead to a 2.5% to 3.33% diagnostic modification.

Is It Possible to Improve Urinary Incontinence and Quality of Life in Female Patients? A Clinical Evaluation of the Efficacy of Top Flat Magnetic Stimulation Technology.

Background and Objectives: Urinary incontinence is the accidental loss of urine that can occur at any age, especially among women over 50; however, its prevalence is increasing. This study aimed to assess the efficacy and safety of a device that uses Top Flat Magnetic Stimulation for the management of women with mixed urinary incontinence. Materials and Methods: A total of 50 female patients underwent a total of six treatment sessions performed twice a week for three consecutive weeks, for 28 min. Three questionnaires were used for the evaluation of the urinary improvements: Urinary Incontinence Short Form (ICIQ-UI-SF), Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB), and Incontinence Impact Questionnaire-Short Form (IIQ-7). The questionnaires were compiled immediately before each treatment, within the treatment period (until the sixth treatment session), and up to 3 months of follow-up. Results: Improvement in quality of life is observed according to the results of the questionnaire, already after six sessions and at three months follow-up. ICIQ-UI-SF’s average score at baseline was 20.2 (±1.1), and it significantly declined (p < 0.01) to 1.8 (±2.4) after six sessions and to 4.8 (±2.8) at 3 months follow-up; ICIQ-OAB’s average score significantly decreased (p < 0.01) from 10.4 (±3.2) at baseline to 1.4 (±0.8) after six sessions and 2.3 (±1.6) at 3 months follow-up. IIQ-7’s average score significantly decreased (p < 0.01) from 20.2 (±1.7) at baseline to 0.4 (±0.5) after six sessions and to 4.7 (±2.8) at 3 months follow-up. Conclusions: Our results suggest that Top Flat Magnetic Stimulation technology can reduce mixed urinary incontinence symptoms for all women examined, leading to an improvement in the patient quality of life and patient awareness of their pelvic floor area with good results.

MP52-10 CLINICAL STUDY OF A NEUROMODULATIVE SLING SYSTEM WITH TVT-XO PROCEDURE IN THE TREATMENT OF MIXED URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-10 CLINICAL STUDY OF A NEUROMODULATIVE SLING SYSTEM WITH TVT-XO PROCEDURE IN THE TREATMENT OF MIXED URINARY INCONTINENCE Hai-Hong Jiang, Xiao-Liang Zhu, Yasmeen Bano, Qi-Xiang Song, Kang-Li Deng, Jiahui Liu, Hongbing Liao, and Meihao Wang Hai-Hong JiangHai-Hong Jiang More articles by this author , Xiao-Liang ZhuXiao-Liang Zhu More articles by this author , Yasmeen BanoYasmeen Bano More articles by this author , Qi-Xiang SongQi-Xiang Song More articles by this author , Kang-Li DengKang-Li Deng More articles by this author , Jiahui LiuJiahui Liu More articles by this author , Hongbing LiaoHongbing Liao More articles by this author , and Meihao WangMeihao Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mixed urinary incontinence (MUI) is a relatively complex medical condition. To evaluate the safety and effectiveness of the neuromodulative sling system with TVT-XO procedure in MUI, we performed surgical treatment and short-term observation on 11 women with severe MUI by using a new neuromodulative sling system combined with a new anti-incontinence TVT-XO suspension procedure. METHODS: A total of 11 adult female patients with severe MUI were included under the following screening criteria: leakage point pressure < 60 cm H2O, severe bladder urgent symptoms (overactive bladder symptom score(OABSS) >12), and no significant improvement after pelvic floor exercise and related medications. The principle of TVT-XO suspension is that two sling tapes crossover stereoscopic suspension of the urethra. The microelectric stimulating lead along the shell of the left suprapubic sling was inserted below the middle and proximal suburethral urethra. The stimulator was then attached to the lead. During neuromodulation after implantation, the urgency can be regulated through feedback. RESULTS: All 11 patients underwent TVT-XO procedure along with the neuomodulative sling system implantation successfully. With neuromodulation treatment one month after surgery, it indicated significant improvements in MUI symptoms, including the short version of questionnaire IIQ7 and the OABSS score (p < 0.05). CONCLUSIONS: Our preliminary study demonstrated the TVT-XO sling procedure along with a new neuromodulative sling can simultaneously improve patients' urinary incontinence and urgency with no serious complications. The limitations of the study include the small number of patients and the short time of the observation. We expected a large-scale trial and long-term observation of the safety and effectiveness. Source of Funding: Zhejiang Provincial Natural Science Foundation of China (No. WY20H050001), Zhejiang Provincial Medical and Health Technology Program projects of China (Nos. 2018PY031, 2018KY512, and 2019KY101), and National Natural Science Foundation of China (No. 81670695) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e933-e933 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hai-Hong Jiang More articles by this author Xiao-Liang Zhu More articles by this author Yasmeen Bano More articles by this author Qi-Xiang Song More articles by this author Kang-Li Deng More articles by this author Jiahui Liu More articles by this author Hongbing Liao More articles by this author Meihao Wang More articles by this author Expand All Advertisement Loading ...

Association between the urogenital microbiome and surgical treatment response in women undergoing midurethral sling operation for mixed urinary incontinence

The urogenital microbiome is associated with urgency and mixed urinary incontinence symptoms and differential treatment responses to pharmacotherapy for urgency urinary incontinence. This study aimed to describe whether the preoperative urinary and vaginal microbiomes were associated with surgical treatment responses at 12 months after a midurethral sling operation in women with mixed urinary incontinence. This cohort study compared the preoperative microbiome compositions of urine and vaginal samples from a subset of women undergoing a midurethral sling operation in the Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence trial (NCT01959347) and compared the microbiota in women who were surgical responders vs surgical nonresponders. Twelve-month objective response was defined as a ≥70% reduction from baseline urinary incontinence episodes on a 3-day diary. Subjective response was defined as a change from baseline in the Urogenital Distress Inventory scores. Bacterial abundance and beta diversity were assessed using 16S ribosomal RNA sequencing. The primary differential abundance analysis described predominant bacterial operational taxonomic units associated with responders vs nonresponders using unadjusted and age-adjusted linear models. Objective nonresponders (n=28) compared with responders (n=72) were older (58.5±10.7 vs 51.6±10.2 years) and more likely postmenopausal without hormone use (odds ratio, 6.4; 95% confidence interval, 1.8-22.6). Vaginal and urinary microbiota beta diversities were associated with age (P<.05) for both responders and nonresponders. Overall, predominant operational taxonomic units (genera) were Lactobacillus, Gardnerella, Tepidimonas, Escherichia, Streptococcus, and Prevotella. Operational taxonomic units from baseline urine samples were not significantly associated (P threshold=.05) with surgical treatment responses. A greater abundance of baseline vaginal Lactobacillus was associated with an objective response (P=.04) and Prevotella with an objective nonresponse (P=.01). Adjusting for age, only a greater abundance of baseline vaginal Prevotella was associated with an objective nonresponse (P=.01). Moreover, less abundant vaginal operational taxonomic units were associated with objective and subjective responses and persistent urinary incontinence symptoms (P<.05). Women meeting a 70% reduction of urinary incontinence treatment episodes (objective responders) had greater vaginal Lactobacillus at the time of the surgical procedure; however, controlling for age diminished this association. Women not meeting a 70% reduction of urinary incontinence episodes 1 year after a midurethral sling operation had greater vaginal Prevotella at the time of the midurethral sling operation. Further research is needed to determine whether therapy altering the vaginal microbiome may impact surgical treatment responses in women with mixed urinary incontinence.

Mixed Urinary Incontinence (MUI) in Women: From Evidence to Clinical Practice

Mixed Urinary Incontinence (MUI) in women is an important disease that is under-treated and under-reported with high prevalence of 33% of all cases of incontinence. It significantly impairs women’s quality of life. MUI usually represent with more severe symptoms and are more likely to present for the treatment as per the recent studies. The management not only includes the conventional but also the complementary and alternative medicine treatment incorporating details from evidence to clinical practice. Combinations of behavioral modification, pelvic floor physiotherapy, biofeedback, pharmacotherapy, anti-incontinence devices, and complementary therapies is useful to treat mixed symptoms. Some researches recommended the use of Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) and antimuscarinic drugs to treat MUI. Some studies showed that acupuncture is beneficial for MUI. The treatment with herbal medicine such as mace, Boswellia serrata and Cyperius were also effective in treating MUI symptoms.

Concurrent Retropubic Midurethral Sling and OnabotulinumtoxinA for Mixed Urinary Incontinence: A Randomized Controlled Trial.

To evaluate whether retropubic midurethral sling combined with onabotulinumtoxinA is more effective than sling alone in improving mixed urinary incontinence symptoms. We conducted a prospective, double-blind, randomized, controlled trial of women with mixed urinary incontinence, planning to undergo midurethral sling. Women were randomly assigned to receive 100 unites of intradetrusor onabotulinumtoxinA or placebo during surgery. Participants completed the PGI-S (Patient Global Impression of Severity), the UDI-6 (Urinary Distress Inventory, Short Form), and the PFIQ-7 (Pelvic Floor Impact Questionnaire-Short Form 7) before and 3 months after surgery, and the primary outcome, PGI-I (Patient Global Impression of Improvement), 3 months postoperatively. Primary outcome was PGI-I score at 3 months for overall incontinence. We considered women "improved" with answers of "very much better" or "much better" on the PGI-I. Assuming a PGI-I response of "improved" in 66% of placebo and 93% of onabotulinumtoxinA participants, 68 women were needed to show a significant difference with 80% power at 0.05 significance level. From March 2016 to November 2019, 78 women completed a 3-month follow-up (onabotulinumtoxinA: 41; placebo: 37). Mean age was 51 years (±10). On the PGI-I, the number who "improved" did not differ between groups at 3 months (83% vs 84%, P=1.0). The onabotulinumtoxinA group had less severe urgency symptoms as indicated by median urgency PGI-S scores (1 [interquartile range 1-2] vs 2 [interquartile range 1-3], P=.033) and greater improvement in urgency symptoms based on median urgency PGI-I score (1 [interquartile range 1-3] vs 2 [interquartile range 2-4], P=.028). At 3 months, median UDI-6, PFIQ-7, and PGI-S scores improved significantly from baseline in both groups. Similarly, UDI-6 and PFIQ-7 scores did not differ between groups. More women in the onabotulinumtoxinA arm initiated intermittent self-catheterization, (3% placebo; 12% onabotulinumtoxinA, P=.20) and experienced urinary tract infections (5% placebo; 22% onabotulinumtoxinA, P=.051), but these did not differ statistically. Concurrent intradetrusor onabotulinumtoxinA injection did not improve overall incontinence symptoms at 3 months compared with placebo among women with mixed urinary incontinence undergoing midurethral sling placement. Women with mixed urinary incontinence undergoing sling report significant improvement in overall incontinence symptoms, regardless of the addition of onabotulinumtoxinA injections, but those receiving concurrent onabotulinumtoxinA injections reported less urgency severity and greater improvement in urgency symptoms at 3 months. ClinicalTrials.gov, NCT02678377.

Primary Retroperitoneal Serous Cystadenoma Mimicking Rectal Duplication Cyst: A Case Report

Background: Primary retroperitoneal serous cystadenomas (PRSCs) are extremely rare, and their pathogenesis is not well understood. Differentiating these tumors from other cystic or tumorigenic lesions can be challenging given the unusual retroperitoneal location and varied symptomatology. Case Presentation: An 83-year-old female was evaluated for vaginal prolapse symptoms, fecal incontinence, and intermittent mixed urinary incontinence symptoms. Magnetic resonance imaging showed a large space-occupying cystic structure closely associated with the rectum. After exploratory laparotomy with excision of the retroperitoneal mass, biopsy showed a simple cyst filled with serous fluid and lined by a single layer of cuboidal epithelial cells consistent with serous cystadenoma. On follow up visit, she reported improvement in stress urinary incontinence, but continued to have difficulty with urinary and bowel urge incontinence. Conclusion: PRSCs should be considered during evaluation of retroperitoneal space-occupying lesions despite the rarity of serous cystadenomas being found in this location. The pathophysiology of how PRSCs arise is still not well understood but establishing better techniques to distinguish these lesions from other cystic and tumorigenic lesions should be investigated.

The natural history of urinary incontinence subtypes in the Nurses’ Health Studies

Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease. To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence. We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome. At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m2 at onset with severe stress urinary incontinence). Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.

Efficacy of mace (Arils of Myristica fragrans Houtt) plus pelvic floor muscle training on symptoms in mixed urinary incontinence: a randomized placebo-controlled trial

BackgroundIt is not only to evaluate the efficacy and safety of mace (Arils of Myristica fragrans Houtt) but also to compare pelvic floor muscle training vs. pelvic floor muscle training (PFMT) for improving symptoms and health-related quality of life (HRQoL) of woman with mixed urinary incontinence (MUI). MethodsA prospective, single-blind randomized controlled study was conducted. Patients (n=60) were randomly allocated (1:1) to receive either mace powder or placebo (1.5g) orally twice daily along with pelvic floor muscle training in both groups for three consecutive months. The primary outcomes included symptom evaluation with Patient Global Impression Index of Improvement (PGI-I) and the Patient Global Impression Index of Severity (PGI-S) for MUI. For safety, clinical examination and biochemical parameters were assessed. Secondary outcomes included Short form of Urogenital Distress Inventory Questionnaire-6 (UDI-6) and quality of life assessment with questionnaire tools such as Short form of Incontinence Impact Questionnaire-7 (IIQ-7), Short form of the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and ICIQ-SF. The data were statistically interpreted with 5% level of significance. ResultsAfter treatment (at third month), the patient reported cure for PGI-I and PGI-S was 46.66% and 90% for the mace group, whereas 0% and 16.66% for the control group, respectively (P<0.001), statistically significant. No side effects were reported in the mace group. The mean difference noted in terms of scores, at the third month from baseline for UDI-6 (51.09 vs. 24.78), IIQ-7 (45.48 vs. 23.49), PISQ (11.33 vs. 5.40), and ICIQ-SF (8.10 vs. 2.43) scores were higher in the mace than that in the control group (P<0.001). ConclusionMace is effective and safe for the subjective improvement of mixed urinary incontinence symptoms and for the improvement of women's HRQoL than the placebo.Clinical Trial Registry No.: CTRI/2017/04/008342

Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome?

Mixed urinary incontinence (MUI), defined as mixed symptoms of stress urinary incontinence (SUI) and overactive bladder (OAB), is a difficult entity if conservative treatment has failed. Cure rates are low compared with SUI, particularly the OAB component, may deteriorate after sling insertion. Bulking agents pose an appealing alternative for the treatment of MUI. They have shown beneficial effect in small case studies, but larger series are lacking. The aim of this prospective study was an analysis of treatment efficacy and safety profile of the bulking agent, Bulkamid, in female patients with MUI. One hundred fifty-four women with MUI symptoms (components of SUI/OAB within the limits of 60-40% either way) received bulking therapy with polyacrylamide hydrogel (Bulkamid). Patients were followed-up 3months postoperatively. Primary outcome was the domain Incontinence impact on the King's Health Questionnaire (KHQ). Secondary outcomes were the other KHQ domains, visual analog scale (VAS), and International Continence Society (ICS) standardized pad weight test as objective measurement of incontinence. Statistically significant improvements were found for all KHQ domains, pad weight test, and the visual analog scale (VAS) before and after bulking. Overall complication rate was 13%. This study has shown improvement in MUI after bulking therapy according to both subjective and objective outcomes. We can advocate bulking therapy for treating MUI, as it is simple and safe and shows both objective and subjective improvement and relief. Long-term results (up to 1year) are awaited.

MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE? Joseph LaBossiere and Sender Herschorn Joseph LaBossiereJoseph LaBossiere More articles by this author and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1970AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Persistent bothersome urinary incontinence occurs in up to 10-15% of men after radical prostatectomy (RP). Urodynamics (UDS) are often utilized in the assessment of men with post-prostatectomy incontinence (PPI). Our objective is to determine how well patient symptoms correlate with UDS in men with PPI. METHODS Retrospective review of a cohort of 496 men referred to our institution with PPI over a 20-year period. All patients with a history of RP were included in the study. All patients had a standardized history as well as the original multichannel UDS and interpretation. RESULTS 496 patients with an average age of 64 were reviewed accounting for 513 studies. UDS were performed on average 3 years after RP. On history, 471 (91%) patients complained of stress urinary incontinence (SUI), 249 (48%) urgency urinary incontinence (UUI) and 207 (40%) had mixed urinary incontinence (MUI). 264 (52%) of patients had only SUI and 42 (8%) only UUI symptoms. 356 of the 471 patients with a history of SUI symptoms had SUI on UDS for a positive predictive value (PPV) of 75%. Negative predictive value (NPV) for SUI symptoms was 78%. 6% of men complaining of SUI symptoms on history had only detrusor overactivity incontinence (DOI) on UDS, and 18% of men with SUI symptoms demonstrated no incontinence on UDS. 108 of the 249 patients with symptoms of UUI had DOI on UDS for a PPV of 43%. NPV for UUI symptoms was 85%. Of the 42 men complaining only of UUI symptoms, 14% had only SUI, 50% had only DOI and 17% had both SUI and DOI on UDS. 19% of men with only UUI symptoms demonstrated no incontinence on UDS. 77% of patients with MUI symptoms had SUI on UDS. CONCLUSIONS 91% of men in this study with PPI presented with some element of SUI symptoms on history. SUI symptoms on history accurately predicts SUI on UDS and rarely identifies only DOI. These data question the routine use of UDS in the workup of men presenting with SUI symptoms after RP prior to treatment. Men complaining only of UUI symptoms on history also predicts for DOI on UDS. UDS may be helpful in this patient group to further guide treatment decisions if initial treatment fails and to rule out SUI. Most men with MUI symptoms will have SUI identified on UDS. © 2017FiguresReferencesRelatedDetailsCited byViers B, VanDyke M, Pagliara T, Shakir N, Scott J and Morey A (2017) Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?Urology Practice, VOL. 5, NO. 6, (458-465), Online publication date: 1-Nov-2018. Volume 197Issue 4SApril 2017Page: e842-e843 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joseph LaBossiere More articles by this author Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial.

Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12months. ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study.

To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence. This 2008-2012 exploratory observational cohort study was conducted with community-dwelling women aged 60 and over. Sixty six women (22 per group), mean age of 67.7 ± 5.2 years, participated in the study. A 3 T MRI examination was conducted under three conditions: rest, PFM MVC, and straining. ANOVA or Kruskal-Wallis tests (data not normally distributed) were conducted, with Bonferroni correction, to compare anatomical measurements between groups. Women with MUI symptoms had a lower PFM resting position (M-Line P = 0.010 and PC/H-line angle P = 0.026) and lower pelvic organ support (urethrovesical junction height P = 0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P = 0.026 and P = 0.008, respectively). There were no significant differences between groups on PFM MVC or straining. Women with SUI and MUI symptoms present different morphological defects at rest. These observations emphasize the need to tailor UI interventions to specific pelvic floor defects and UI type in older women. Older women with UI demonstrate different problems with their pelvic organ support structures depending on the type of UI. These new findings should be taken into consideration for future research into developing new treatment strategies for UI in older women. Neurourol. Urodynam. 35:515-521, 2016. © 2015 Wiley Periodicals, Inc.

Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study

Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs.

Does the onset or bother of mixed urinary incontinence symptoms help in the urodynamic diagnosis?

ObjectiveTo determine whether evaluation of the first occurring symptom and bother of mixed urinary incontinence (MUI) might help in the clinical assessment of incontinent women. Study designProspective observational study carried out in a tertiary referral urogynaecology unit in London. Women who underwent urodynamic investigations for MUI were asked whether stress or urgency incontinence was the first occurring symptom and which was the most bothersome one. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the first occurring symptom and most bothersome component of their mixed urinary incontinence symptoms in relation to the urodynamic diagnosis were calculated. ResultsOne hundred and eighty women with MUI were studied. Initial or most bothersome urgency urinary incontinence (UUI) had a good specificity and PPV for diagnosing detrusor overactivity (DO). When UUI was the initial and most bothersome symptom the specificity and NPV increased up to 93% and 73%. Stress urinary incontinence (SUI) as first occurring or most bothersome had a moderate specificity, PPV and NPV for diagnosing urodynamic stress incontinence (USI). When SUI was the initial and most bothersome symptom the specificity, PPV and NPV increased up to 91%, 70% and 78%. Initial or most bothersome UUI with antecedent or most bothersome SUI had a high specificity and good NPV for a mixed urodynamic diagnosis of DO and USI. ConclusionsDetermination of the first occurring and most bothersome symptom in women with MUI relates closely to the urodynamic diagnosis. Therefore, our symptom-guided approach may in some cases provide useful information directing the clinician towards a more appropriate therapy when urodynamics are inconclusive or cannot be performed.

Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis

Mixed urinary incontinence (MUI) is a coexistence of stress (SUI) and urgency urinary incontinence (UUI). There is conflicting evidence on the effectiveness of midurethral slings (MUS) in this condition. The objective of this study is to evaluate the effectiveness of MUS in women with MUI by systematic review of the literature. Systematic literature search was carried (June 2010) using relevant search terms in Medline, EMBASE, CENTRAL and Google Scholar. Relevant randomised controlled trials (RCT) and prospective studies were selected and then analysed by two independent reviewers. Meta-analysis was performed with random effects model using STATA 8. There were six randomised trials and seven prospective studies with average to good quality included in this systematic review. There was heterogeneity in outcomes reported. The overall subjective cure from seven prospective nonrandomised studies that included patients with symptomatic ± urodynamically proven MUI was found to be 56.4% (95% confidence interval 45.7-69.6%) at 34.9 ± 22.9 months follow-up. The overall cure of urgency and UUI component was 30-85% at a follow-up of few months up to 5 years. Most of the studies described that this cure does not persist over the time. The cure rate of SUI following MUS varies from 85% to 97%. On meta-analysis of five RCTs which included women with MUI symptoms, the odds of overall subjective cure with TVT versus transobturator tapes are similar at 6-33 months follow-up (OR, 0.9; 95% CI, 0.63-1.27). This was true when a subgroup analysis was performed on women with MUI who were negative for DO on UDS (OR, 1.21; 95% CI, 0.7-2.08) There is evidence of persistent and good cure of stress component following MUS in women with MUI. The cure of the urge component is variable but less than stress component. Methodologically sound RCTs of retropubic and transobturator tapes with long-term follow-up are needed specifically for women with urodynamically proven and symptomatic mixed incontinence.

Management of Stress Urinary Incontinence Following a Failed Midurethral Tape

Up to 86% of incontinent women complain of stress urinary incontinence (SUI), making it the most common symptom [1]. More than 200 surgical procedures have been described in the literature for the treatment of SUI [2]. Recently, midurethral tapes have become the gold standard procedure for surgical management [3]. The tension-free vaginal tape procedure has been shown to cure 80% to 90% of patients with long-term effectiveness [4]. Reported cure rates for the transobturator midurethral tapes range from 66% to 90% [5]. However, a small proportion of patients experience surgical failure. Symptoms of mixed urinary incontinence and detrusor overactivity, as well as concurrent prolapse surgery and increased age have been identified as potential risk factors for failure of retropubic tapes [6, 7]. A history of previous incontinence surgery, low maximal urethral closure pressure, concurrent prolapse surgery, and increasing age have been proposed as risk factors for failure of transobturator tapes. The management of persistent or recurrent SUI after failed midurethral tape presents a new challenge.

The correlation between clinical and urodynamic diagnosis in classifying the type of urinary incontinence in women. A systematic review of the literature

To determine the reclassification rate of clinically diagnosed stress, mixed, and urge urinary incontinence after urodynamic investigation. A systematic review of the published literature in MEDLINE and EMBASE of clinical trials among women with urinary incontinence. Studies were included in case the diagnosis based on symptoms and/or signs was compared with the diagnosis after urodynamic investigation. Twenty-three articles involving 6,282 women with urinary incontinence met the inclusion criteria. A clinical diagnosis of stress urinary incontinence was reclassified into mixed urinary incontinence in 9% of women and into detrusor overactivity (DO) in 7% of cases. The pooled reclassification rate was highest among patients with symptoms of mixed urinary incontinence, where 46% of the patients had stress urinary incontinence and 21% had DO on urodynamic investigation. The available literature does not allow the identification of the additional value of non-invasive test, such as stress test and voiding diary, accessory to symptoms. None of the studies had therapeutic effects as an outcome measure. This review of clinical studies shows that the level of agreement between classification based on clinical evaluation and based on urodynamic investigation is poor. Urodynamic observations are regarded as gold standard, but based on the poor correlation, this assumption should be questioned.

A Comparison of Transobturator Versus Retropubic Midurethral Slings for Mixed Urinary Incontinence

: The primary objective of this study was to compare improvement and/or cure of mixed urinary incontinence (MUI) symptoms after retropubic (RP) versus transobturator (TO) slings. The secondary objective was to compare improvement and/or cure of the urge urinary incontinence (UUI) component of MUI. : This retrospective cohort study included all patients with MUI who underwent a midurethral sling from January 2006 to May 2007. IRB approval was obtained to perform telephone interviews to collect the Patient Global Impression of Improvement (PGI-I) questionnaire for MUI and to elicit any changes in the SUI and/or UUI components of MUI. The primary outcome was based on a 7-point Likert scale for the PGI-I questionnaire. The secondary outcome was improvement or resolution of the UUI component of MUI based on a 4-point Likert scale of patient responses to the question, "Is your urge incontinence worse, the same, or improved after surgery?" Subjects who had RP slings were compared with those with TO with respect to these outcomes. Patient satisfaction, adverse events, urinary retention, and worsening of urge incontinence symptoms were also assessed. : For the primary outcome (MUI), no significant difference was found in the PGI-I scores between the 2 groups. Similarly, no difference was found in UUI improvement/resolution between the 2 groups. UUI improvement was noted in 46.4% of the TO group and 56.5% of the RP group, and UUI cure in 39.3% of the TO group and 26.1% of the RP group. An 84.3% overall improvement/cure rate of UUI was noted when both groups were combined. Ten (19.6%) women required anticholinergic use after slings. A total of 52.6% of subjects were "completely satisfied" and 14.3% were "not at all satisfied" with the procedure in the TO group, versus 65.2% and 7.7% in the RP group (Mann-Whitney U test, P = 0.23). There was no difference in perioperative adverse events between the 2 groups. : RP and TO slings result in similar global improvement in MUI symptoms. A total of 84.3% of patients undergoing RP or TO sling for MUI have improvement/cure of the UUI component.