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International Urogynecology Journal
Published in: International Urogynecology Journal 10/2014

01-10-2014 | Special Contribution

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

Authors: Dorothy Kammerer-Doak, Diaa E. E. Rizk, Olanrewaju Sorinola, Wael Agur, Sharif Ismail, Tony Bazi

Published in: International Urogynecology Journal | Issue 10/2014

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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.
Literature
1.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26PubMedCrossRef
2.
3.
Minassian VA, Drutz HP, Al-Badr A (2003) Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet 82:327–338PubMedCrossRef
4.
Lifford KL, Townsend MK, Curhan GC, Resnick NM, Grodstein F (2008) The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc 56:1191–1198PubMedCrossRef
5.
Brubaker L, Stoddard A, Zimmern P, Network UIT et al (2009) Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn 28:268–273PubMedPubMedCentralCrossRef
6.
7.
Khullar V, Cardozo L, Dmochowski R (2010) Mixed incontinence: current evidence and future perspectives. Neurourol Urodyn 29:618–622PubMedCrossRef
8.
Thüroff JW, Abrams P, Andersson KE et al (2011) EAU guidelines on urinary incontinence. Eur Urol 59:387–400PubMedCrossRef
9.
Katsumi HK, Rutman MP (2010) Can we predict if overactive bladder symptoms will resolve after sling surgery in women with mixed urinary incontinence? Curr Urol Rep 11:328–337PubMedCrossRef
10.
Bradley CS, Rovner ES, Morgan MA et al (2005) A new questionnaire for urinary incontinence diagnosis in women: development and testing. Am J Obstet Gynecol 192:66–73PubMedCrossRef
11.
Bent AE, Gousse AE, Hendrix SL, Klutke CG, Monga AK, Yuen CK, From the Duloxetine Mixed Urinary Incontinence Study Group et al (2005) Validation of a two-item quantitative questionnaire for the triage of women with urinary incontinence. Obstet Gynecol 106(4):767–773PubMedCrossRef
12.
13.
Digesu GA, Salvatore S, Fernando R, Khullar V (2008) Mixed urinary symptoms: what are the urodynamic findings? Neurourol Urodyn 27:372–375PubMedCrossRef
14.
Panayi DC, Duckett J, Digesu GA, Camarata M, Basu M, Khullar V (2009) Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence. Neurourol Urodyn 28:82–85PubMedCrossRef
15.
Paick JS, Oh SJ, Kim SW, Ku JH (2008) Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J 19:123–129CrossRef
16.
Gamble TL, Botros SM, Beaumont JL et al (2008) Predictors of persistent detrusor overactivity after transvaginal sling procedures. Am J Obstet Gynecol 199(696):e1–e7PubMed
17.
Lee JK, Dwyer PL, Rosamilia A, Lim YN, Polyakov A, Stav K (2011) Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG 118:798–805PubMedCrossRef
18.
Wolter CE, Kaufman MR, Duffy JW, Scarpero HM, Dmochowski RR (2011) Mixed incontinence and cystocele: postoperative urge symptoms are not predicted by preoperative urodynamics. Int Urogynecol J 22:321–325PubMedCrossRef
19.
Burgio KL, Goode PS, Locher JL et al (2003) Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol 102:940–947PubMedCrossRef
20.
21.
Kincade JE, Dougherty MC, Carlson JR, Hunter GS, Busby-Whitehead J (2007) Randomized clinical trial of efficacy of self-monitoring techniques to treat urinary incontinence in women. Neurourol Urodyn 26:507–511PubMedCrossRef
22.
23.
Townsend MK, Jura YH, Curhan GC et al (2011) Fluid intake and risk of stress, urgency and mixed urinary incontinence. Am J Obstet Gynecol 205(73):e1–e6PubMed
24.
Hunskaar S (2009) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27:749–757CrossRef
25.
26.
Kim H, Yoshida H, Suzuki T (2011) The effects of multidimensional exercise treatment on community-dwelling elderly Japanese women with stress, urge, and mixed urinary incontinence: a randomized controlled trial. Int J Nurs Stud 48:1165–1172PubMedCrossRef
27.
Dumoulin C, Hay-Smith J (2010) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 20(1), CD005654
28.
Herderschee R, Hay-Smith EJC, Herbison GP et al (2011) Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database Syst Rev 6(7), CD009252
29.
Roe B, Ostaszkiewicz J, Milne J, Wallace S (2007) Systematic reviews of bladder training and voiding programmes in adults: a synopsis of findings from data analysis and outcomes using metastudy techniques. J Adv Nurs 57:15–31PubMedCrossRef
30.
Fall M, Lindstron S (1998) Functional electrical stimulation: physiological basis and clinical principles. Int Urogynecol J 5:296CrossRef
31.
Amaro JL, Gameiro MOO, Padovani CR (2003) Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy. Int Urogynecol J 14:204–208CrossRef
32.
Amaro JL, Gameiro MO, Padovani CR (2005) Effect of intravaginal electrical stimulation on pelvic floor strength. Int Urogynecol J 16:355–358CrossRef
33.
Amaro JL, Gameiro MO, Kawano PR et al (2006) Intravaginal electrical stimulation: a randomized, double-blind study on the treatment of mixed urinary incontinence. Acta Obstet Gynecol 85:619–622CrossRef
34.
Brubaker LT, Benson JT, Bent A et al (1993) Transvaginal electrical stimulation for female urinary incontinence. Am J Obstet Gynecol 177:536–540CrossRef
35.
Brubaker L, Benson JT, Bent A et al (1997) Transvaginal electrical stimulation for female urinary incontinence. Am J Obstet Gynecol 177:536–540PubMedCrossRef
36.
Donnelly MJ, Powell-Morgan S, Olsen AL et al (2004) Vaginal pessaries for the management of stress and mixed urinary incontinence. Int Urogynecol J 15:302–307
37.
Richter HE, Burgio KL, Brubaker L, Nygaard IE, Ye W, Weidner A, for Pelvic Floor Disorder Network et al (2010) Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 115:609–617PubMedPubMedCentralCrossRef
38.
Chang PL (1988) Urodynamic studies in acupuncture for women with frequency, urgency and dysuria. J Urol 140:563–566PubMed
39.
Bergstrom K, Carlsson CP, Lindholm C et al (2000) Improvement of urge- and mixed-type incontinence after acupuncture treatment among elderly women - a pilot study. J Auton Nerv Syst 79:173–180PubMedCrossRef
40.
Emmons SL, Otto L (2005) Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol 106:138–143PubMedCrossRef
41.
Engberg S, Cohen S, Sereika SM (2009) The efficacy of acupuncture in treating urge and mixed incontinence in women: a pilot study. J Wound Ostomy Continence Nurs 36:661–670PubMedCrossRef
42.
Dmochowski RR, Staskin D (2005) Mixed incontinence: definitions, outcomes, and interventions. Curr Opin Urol 15:374–379PubMedCrossRef
43.
Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A (2012) Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 17(10), CD001405
44.
Bump RC, Norton PA, Zinner NR, Yalcin I (2003) Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol 102:76–83PubMedCrossRef
45.
Dmochowski RR, Davila GW, Zinner NR, Gittelman MC, Saltzstein DR, Lyttle S, Sanders SW, For The Transdermal Oxybutynin Study Group (2002) Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. J Urol 168:580–586PubMedCrossRef
46.
47.
Kreder KJ Jr, Brubaker L, Mainprize T (2003) Tolterodine is equally effective in patients with mixed incontinence and those with urge incontinence alone. BJU Int 92:418–421PubMedCrossRef
48.
Khullar V, Hill S, Laval KU et al (2004) Treatment of urge predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Urology 64:269–274PubMedCrossRef
49.
Staskin DR, Te AE (2006) Short- and long-term efficacy of solifenacin treatment in patients with symptoms of mixed urinary incontinence. BJU Int 97:1256–1261PubMedCrossRef
50.
Kelleher C, Cardozo L, Kobashi K, Lucente V (2006) Solifenacin: as effective in mixed urinary incontinence as in urge urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 17:382–388PubMedCrossRef
51.
Dmochowski RR, Sand PK, Zinner NR et al (2003) Comparative efficacy and safety of transdermal oxybutynin and oral tolterodine versus placebo in previously treated patients with urge and mixed urinary incontinence. Urology 62:237–342PubMedCrossRef
52.
Wagg A, Khullar V, Michel MC, Oelke M, Darekar A, Bitoun CE (2014) Long-term safety, tolerability and efficacy of flexible-dose fesoterodine in elderly patients with overactive bladder: open-label extension of the SOFIA trial. Neurourol Urodyn 33:106–114PubMedCrossRef
53.
Brostrøm S, Hallas J (2009) Persistence of antimuscarinic drug use. Eur J Clin Pharmacol 65:309–314PubMedCrossRef
54.
Caremel R, Loutochin O, Corcos J (2014) What do we know and not know about mirabegron, a novel β3 agonist, in the treatment of overactive bladder? Int Urogynecol J 25:165–170PubMedCrossRef
55.
Bent AE, Gousse AE, Hendrix SL et al (2008) Duloxetine compared with placebo for the treatment of women with mixed urinary incontinence. Neurourol Urodyn 27:212–221PubMedCrossRef
56.
van Leeuwen JHS, Lange RR, Jonasson AF, Chen WJ, Viktrup L (2008) Efficacy and safety of duloxetine in elderly women with stress urinary incontinence or stress-predominant mixed urinary incontinence. Maturitas 60:138–147CrossRef
57.
Hunskaar S, Welle-Nilsen LK (2010) The market lifecycle of duloxetine for urinary incontinence in Norway. Acta Obstet Gynecol Scand 89:217–222PubMedCrossRef
58.
Vella M, Duckett J, Basu M (2008) Duloxetine 1 year on: the long-term outcome of a cohort of women prescribed duloxetine. Int Urogynecol J Pelvic Floor Dysfunct 19:961–964PubMedCrossRef
59.
60.
Kim YT, Park JS, Lim KT, Moon HS (2012) Efficacy analysis of transurethral trigone submucosal deafferentation procedure plus trans-obturator sling versus transobturator sling alone in the treatment of mixed urinary incontinence. Neurourol Urodyn 31:1062–1063
61.
Juang CM, Yu KJ, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL (2007) Efficacy analysis of trans-obturator tension-free vaginal tape (TVT-O) plus modified Ingelman-Sundberg procedure versus TVT-O alone in the treatment of mixed urinary incontinence: a randomized study. Eur Urol 51(6):1671–1678PubMedCrossRef
62.
Jain P, Jirschele K, Botros SM, Latthe PM (2011) Effectiveness of midurethral slings in mixed urinary incontinence; a systematic review and meta-analysis. Int Urogynecol J 22:923–932PubMedCrossRef
63.
Sinha D, Blackwell A, Moran PA (2008) Outcome measures after TVT for mixed urinary incontinence. Int Urogynecol J 19:927–931CrossRef
64.
Kulseng-Hanssen S, Husby H, Schiotz HA (2008) Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. Int Urogynecol J 19:391–396CrossRef
65.
Deffieux X, Donnadieu AC, Porcher R, Gervaise A, Frydman R, Fernandez H (2007) Long-term results of tension-free vaginal tape for female urinary incontinence: follow up over 6 years. Int J Urol 14:521–526PubMedCrossRef
66.
Athanasiou S, Grigoriadis T, Giannoulis G, Protopapas A, Antsaklis A (2013) Midurethral slings for women with urodynamic mixed incontinence: what to expect? Int Urogynecol J 24:393–399PubMedCrossRef
67.
Duckett JR, Basu M (2010) TVT vs TOT: a case controlled study in patients with mixed urodynamic stress incontinence and detrusor overactivity. Int Urogynecol J 21:763–736PubMedCrossRef
68.
Demirci F, Yucel O, Eren S, Alkan A, Demirci E, Yildirim U (2001) Long-term results of Burch colposuspension. Gynecol Obstet Investig 51:243–247CrossRef
69.
Eriksen BC, Hagen B, Eik-Nes SH, Molne K, Mjolnerod OK, Romslo I (1990) Long-term effectiveness of the Burch colposuspension in female urinary stress incontinence. Acta Obstet Gynecol Scand 69:45–50PubMedCrossRef
70.
Colombo M, Zanetta G, Vitobello D, Milani R (1996) The Burch colposuspension for women with and without detrusor overactivity. Br J Obstet Gynaecol 103:255–260PubMedCrossRef
71.
del Campo-Rodriguez M, Batista-Miranda JE, Errando-Smet C, Arano-Bertran P (1999) Outcome of colposuspension in patients with stress urinary incontinence and abnormal cystometry. Arch Esp Urol 52(7):810–814PubMed
72.
Akpinar H, Cetinel B, Demirkesen O, Tufek I, Yaycioglu O, Solok V (2000) Long-term results of Burch colposuspension. Int J Urol 7:119–125PubMedCrossRef
73.
Scotti RJ, Angell G, Flora R, Greston WM (1998) Antecedent history as a predictor of surgical cure of urgency symptoms in mixed incontinence. Obstet Gynecol 91:51–54PubMedCrossRef
74.
Coyne KS, Zhou Z, Thompson C, Versi E (2003) The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU Int 92:731–735PubMedCrossRef
75.
Chou EC, Flisser AJ, Panagopoulos G, Blaivas JG (2003) Effective treatment for mixed urinary incontinence with a pubovaginal sling. J Urol 170(2 Pt 1):494–497PubMedCrossRef
76.
Stoffel JT, Smith JJ, Crivellaro S, Bresette JF (2008) Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling? Int Braz J Urol 34(6):765–771PubMedCrossRef
77.
Toozs-Hobson P, Al-Singary W, Fynes M, Tegerstedt G, Lose G (2012) Two-year follow-up of an open-label multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and stress-predominant mixed incontinence. Int Urogynecol J 23:1373–1378PubMedPubMedCentralCrossRef
78.
Khan S, Panicker J, Roosen A, Gonzales G, Elneil S, Dasgupta P, Fowler CJ, Kessler TM (2010) Complete continence after botulinum neurotoxin type a injections for refractory idiopathic detrusor overactivity incontinence: patient-reported outcome at 4 weeks. Eur Urol 57:891–896PubMedCrossRef
Metadata
Title
Mixed urinary incontinence: international urogynecological association research and development committee opinion
Authors
Dorothy Kammerer-Doak
Diaa E. E. Rizk
Olanrewaju Sorinola
Wael Agur
Sharif Ismail
Tony Bazi
Publication date
01-10-2014
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 10/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-014-2485-8

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