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Published in: Current Urology Reports 6/2010

01-11-2010

Overactive Bladder and Mixed Incontinence

Authors: Sunshine Murray, Gary E. Lemack

Published in: Current Urology Reports | Issue 6/2010

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Abstract

Mixed urinary incontinence (MUI) is a complex problem and a difficult one to treat. Successful outcome associated with treatment depends on alleviation of not one, but two symptoms. This review addresses the definition, etiology, workup, and treatment of MUI. It encompasses conservative, pharmacological, and surgical therapies along with their outcomes in these complicated patients.
Literature
1.
go back to reference Stewart WF, Van Rooyen JB, Cundiff GW, et al.: Prevalence and burden of overactive bladder in the United States. World J Urol 2003, 20:327–336.PubMed Stewart WF, Van Rooyen JB, Cundiff GW, et al.: Prevalence and burden of overactive bladder in the United States. World J Urol 2003, 20:327–336.PubMed
2.
go back to reference Hannestad YS, Rortveit G, Sandvik H, Hunskaar S: A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol 2000, 53:1150–1157.CrossRefPubMed Hannestad YS, Rortveit G, Sandvik H, Hunskaar S: A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol 2000, 53:1150–1157.CrossRefPubMed
3.
go back to reference • Minassian VA, Stewart WF, Wood GC: Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol 2008, 111:324–331. This is an epidemiological study based on the National Health and Nutrition Examination Survey 2001-2002 data looking at the prevalence and risk factors of urinary incontinence.PubMed • Minassian VA, Stewart WF, Wood GC: Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol 2008, 111:324–331. This is an epidemiological study based on the National Health and Nutrition Examination Survey 2001-2002 data looking at the prevalence and risk factors of urinary incontinence.PubMed
4.
go back to reference Papanicolaou S, Pons ME, Hampel C, et al.: Medical resource utilisation and cost of care for women seeking treatment for urinary incontinence in an outpatient setting. Examples from three countries participating in the PURE study. Maturitas 2005, 52(Suppl 2):S35–S47.CrossRefPubMed Papanicolaou S, Pons ME, Hampel C, et al.: Medical resource utilisation and cost of care for women seeking treatment for urinary incontinence in an outpatient setting. Examples from three countries participating in the PURE study. Maturitas 2005, 52(Suppl 2):S35–S47.CrossRefPubMed
5.
go back to reference Grimby A, Milsom I, Molander U, et al.: The influence of urinary incontinence on the quality of life of elderly women. Age Ageing 1993, 22:82–89.CrossRefPubMed Grimby A, Milsom I, Molander U, et al.: The influence of urinary incontinence on the quality of life of elderly women. Age Ageing 1993, 22:82–89.CrossRefPubMed
6.
go back to reference Chiaffarino F, Parazzini F, Lavezzari M, Giambanco V: Impact of urinary incontinence and overactive bladder on quality of life. Eur Urol 2003, 43:535–538.CrossRefPubMed Chiaffarino F, Parazzini F, Lavezzari M, Giambanco V: Impact of urinary incontinence and overactive bladder on quality of life. Eur Urol 2003, 43:535–538.CrossRefPubMed
7.
go back to reference • Frick AC, Huang AJ, Van den Eeden SK, et al.: Mixed urinary incontinence: greater impact on quality of life. J Urol 2009, 182:596–600. This cross-sectional analysis of a population-based cohort of 2109 women looked at prevalence of incontinence and disease-specific QOL impact between SUI, UUI, and MUI.CrossRefPubMed • Frick AC, Huang AJ, Van den Eeden SK, et al.: Mixed urinary incontinence: greater impact on quality of life. J Urol 2009, 182:596–600. This cross-sectional analysis of a population-based cohort of 2109 women looked at prevalence of incontinence and disease-specific QOL impact between SUI, UUI, and MUI.CrossRefPubMed
8.
go back to reference Papanicolaou S, Hunskaar S, Lose G, Sykes D: Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU Int 2005, 96:831–838.CrossRefPubMed Papanicolaou S, Hunskaar S, Lose G, Sykes D: Assessment of bothersomeness and impact on quality of life of urinary incontinence in women in France, Germany, Spain and the UK. BJU Int 2005, 96:831–838.CrossRefPubMed
9.
go back to reference • Schimpf MO, Patel M, O’Sullivan DM, Tulikangas PK: Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2009, 20:781–786. This retrospective review of 465 women with UUI, SUI, or MUI and control patients (no incontinence) evaluating quality of life with prospectively obtained questionnaires found that women with UUI or MUI have lower quality-of-life scores than control patients and those with SUI alone.CrossRefPubMed • Schimpf MO, Patel M, O’Sullivan DM, Tulikangas PK: Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2009, 20:781–786. This retrospective review of 465 women with UUI, SUI, or MUI and control patients (no incontinence) evaluating quality of life with prospectively obtained questionnaires found that women with UUI or MUI have lower quality-of-life scores than control patients and those with SUI alone.CrossRefPubMed
10.
go back to reference Coyne KS, Zhou Z, Thompson C, Versi E: The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU Int 2003, 92:731–735.CrossRefPubMed Coyne KS, Zhou Z, Thompson C, Versi E: The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU Int 2003, 92:731–735.CrossRefPubMed
11.
go back to reference Melville JL, Delaney K, Newton K, Katon W: Incontinence severity and major depression in incontinent women. Obstet Gynecol 2005, 106:585–592.PubMed Melville JL, Delaney K, Newton K, Katon W: Incontinence severity and major depression in incontinent women. Obstet Gynecol 2005, 106:585–592.PubMed
12.
go back to reference Nygaard I, Turvey C, Burns TL, et al.: Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 2003, 101:149–156.CrossRefPubMed Nygaard I, Turvey C, Burns TL, et al.: Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 2003, 101:149–156.CrossRefPubMed
13.
go back to reference • 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. Neurourol Urodyn 2010, 29:4–20. This is an update on the terminology used in female pelvic floor dysfunction providing standard definitions for commonly used terms in the field.PubMed • 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. Neurourol Urodyn 2010, 29:4–20. This is an update on the terminology used in female pelvic floor dysfunction providing standard definitions for commonly used terms in the field.PubMed
14.
go back to reference Jung SY, Fraser MO, Ozawa H, et al.: Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol 1999, 162:204–212.CrossRefPubMed Jung SY, Fraser MO, Ozawa H, et al.: Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol 1999, 162:204–212.CrossRefPubMed
15.
go back to reference Koonings PP, Bergman A: Urethral pressure changes in women with detrusor instability. Bladder or urethral pathologic process? Urology 1991, 37:540–542.CrossRefPubMed Koonings PP, Bergman A: Urethral pressure changes in women with detrusor instability. Bladder or urethral pathologic process? Urology 1991, 37:540–542.CrossRefPubMed
16.
go back to reference Wise BG, Cardozo LD, Cutner A, et al.: Prevalence and significance of urethral instability in women with detrusor instability. Br J Urol 1993, 72:26–29.CrossRefPubMed Wise BG, Cardozo LD, Cutner A, et al.: Prevalence and significance of urethral instability in women with detrusor instability. Br J Urol 1993, 72:26–29.CrossRefPubMed
17.
go back to reference Koonings P, Bergman A, Ballard CA: Combined detrusor instability and stress urinary incontinence: where is the primary pathology? Gynecol Obstet Invest 1988, 26:250–256.CrossRefPubMed Koonings P, Bergman A, Ballard CA: Combined detrusor instability and stress urinary incontinence: where is the primary pathology? Gynecol Obstet Invest 1988, 26:250–256.CrossRefPubMed
18.
go back to reference Major H, Culligan P, Heit M: Urethral sphincter morphology in women with detrusor instability. Obstet Gynecol 2002, 99:63–68.CrossRefPubMed Major H, Culligan P, Heit M: Urethral sphincter morphology in women with detrusor instability. Obstet Gynecol 2002, 99:63–68.CrossRefPubMed
19.
go back to reference • Gamble TL, Botros SM, Beaumont JL, et al.: Predictors of persistent detrusor overactivity after transvaginal sling procedures. Am J Obstet Gynecol 2008, 199:696.e1–696.e7. This retrospective review looked at 305 women with MUI who underwent sling, finding that transobturator slings had the lowest rate of persistent DO. Other predictors of persistent DO included age, nocturia, maximum cystometric capacity, DO volume, urethral closure pressure, and maximum urinary flow rate.CrossRef • Gamble TL, Botros SM, Beaumont JL, et al.: Predictors of persistent detrusor overactivity after transvaginal sling procedures. Am J Obstet Gynecol 2008, 199:696.e1–696.e7. This retrospective review looked at 305 women with MUI who underwent sling, finding that transobturator slings had the lowest rate of persistent DO. Other predictors of persistent DO included age, nocturia, maximum cystometric capacity, DO volume, urethral closure pressure, and maximum urinary flow rate.CrossRef
20.
go back to reference • Alperin M, Abrahams-Gessel S, Wakamatsu MM: Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk. Neurourol Urodyn 2008, 27:407–411. This is a retrospective review of 92 women undergoing sling surgery, of which 25 developed de novo UUI. When looking at clinical and urodynamic predictors of de novo UUI, only increased daytime frequency and filling detrusor pressure greater than 15 cm H 2 O were found to be predictors.CrossRefPubMed • Alperin M, Abrahams-Gessel S, Wakamatsu MM: Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk. Neurourol Urodyn 2008, 27:407–411. This is a retrospective review of 92 women undergoing sling surgery, of which 25 developed de novo UUI. When looking at clinical and urodynamic predictors of de novo UUI, only increased daytime frequency and filling detrusor pressure greater than 15 cm H 2 O were found to be predictors.CrossRefPubMed
21.
go back to reference Khullar V, Hill S, Laval KU, et al.: Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Urology 2004, 64:269–274.CrossRefPubMed Khullar V, Hill S, Laval KU, et al.: Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Urology 2004, 64:269–274.CrossRefPubMed
22.
go back to reference Bump RC, Norton PA, Zinner NR, Yalcin I: Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol 2003, 102:76–83.CrossRefPubMed Bump RC, Norton PA, Zinner NR, Yalcin I: Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol 2003, 102:76–83.CrossRefPubMed
23.
go back to reference Hashim H, Abrams P: Is the bladder a reliable witness for predicting detrusor overactivity? J Urol 2006, 175:191–194.CrossRefPubMed Hashim H, Abrams P: Is the bladder a reliable witness for predicting detrusor overactivity? J Urol 2006, 175:191–194.CrossRefPubMed
24.
go back to reference Digesu GA, Khullar V, Cardozo L, Salvatore S: Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn 2003, 22:105–108. (Published erratum appears in Neurourol Urodyn 2003, 22:356.)CrossRefPubMed Digesu GA, Khullar V, Cardozo L, Salvatore S: Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn 2003, 22:105–108. (Published erratum appears in Neurourol Urodyn 2003, 22:356.)CrossRefPubMed
25.
go back to reference • Digesu GA, Salvatore S, Fernando R, Khullar V: Mixed urinary symptoms: what are the urodynamic findings? Neurourol Urodyn 2008, 27:372–375. This is a retrospective review of 1626 women who reported MUI at referral to a tertiary referral center for urodynamics that found women with urge-predominant MUI, based on questionnaire data, are more likely to have DO on urodynamics and those with stress-predominant MUI are more likely to have urodynamic stress incontinence.CrossRefPubMed • Digesu GA, Salvatore S, Fernando R, Khullar V: Mixed urinary symptoms: what are the urodynamic findings? Neurourol Urodyn 2008, 27:372–375. This is a retrospective review of 1626 women who reported MUI at referral to a tertiary referral center for urodynamics that found women with urge-predominant MUI, based on questionnaire data, are more likely to have DO on urodynamics and those with stress-predominant MUI are more likely to have urodynamic stress incontinence.CrossRefPubMed
26.
go back to reference Kuo HC: Effect of detrusor function on the therapeutic outcome of a suburethral sling procedure using a polypropylene sling for stress urinary incontinence in women. Scand J Urol Nephrol 2007, 41:138–143.CrossRefPubMed Kuo HC: Effect of detrusor function on the therapeutic outcome of a suburethral sling procedure using a polypropylene sling for stress urinary incontinence in women. Scand J Urol Nephrol 2007, 41:138–143.CrossRefPubMed
27.
go back to reference • Stoffel JT, Smith JJ, Crivellaro S, Bresette JF: Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling? Int Braz J Urol 2008, 34:765–771. This retrospective review looking at 73 women who underwent pubovaginal sling for treatment of MUI, both with and without DO, found similar reductions in daily pad usage, but smaller improvement in UDI-6 scores among those with DO when compared to those without.CrossRefPubMed • Stoffel JT, Smith JJ, Crivellaro S, Bresette JF: Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling? Int Braz J Urol 2008, 34:765–771. This retrospective review looking at 73 women who underwent pubovaginal sling for treatment of MUI, both with and without DO, found similar reductions in daily pad usage, but smaller improvement in UDI-6 scores among those with DO when compared to those without.CrossRefPubMed
28.
go back to reference • Panayi DC, Duckett J, Digesu GA, et al.: Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence. Neurourol Urodyn 2009, 28:82–85. This is a retrospective review of 51 women with both urodynamic SUI and DO who underwent TVT, of which 35 had postoperative UDS. Of the studied patients, 19 had persistent DO postoperatively, with the only significant difference found between those with and without persistent DO being higher median preoperative opening detrusor pressure.CrossRefPubMed • Panayi DC, Duckett J, Digesu GA, et al.: Pre-operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre-operative mixed urinary incontinence. Neurourol Urodyn 2009, 28:82–85. This is a retrospective review of 51 women with both urodynamic SUI and DO who underwent TVT, of which 35 had postoperative UDS. Of the studied patients, 19 had persistent DO postoperatively, with the only significant difference found between those with and without persistent DO being higher median preoperative opening detrusor pressure.CrossRefPubMed
29.
go back to reference Waetjen LE, Liao S, Johnson WO, et al.: Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women’s health across the nation. Am J Epidemiol 2007, 165:309–318.CrossRefPubMed Waetjen LE, Liao S, Johnson WO, et al.: Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women’s health across the nation. Am J Epidemiol 2007, 165:309–318.CrossRefPubMed
30.
go back to reference Danforth KN, Townsend MK, Lifford K, et al.: Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol 2006, 194:339–345.CrossRefPubMed Danforth KN, Townsend MK, Lifford K, et al.: Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol 2006, 194:339–345.CrossRefPubMed
31.
go back to reference Subak LL, Whitcomb E, Shen H, et al.: Weight loss: a novel and effective treatment for urinary incontinence. J Urol 2005, 174:190–195.CrossRefPubMed Subak LL, Whitcomb E, Shen H, et al.: Weight loss: a novel and effective treatment for urinary incontinence. J Urol 2005, 174:190–195.CrossRefPubMed
32.
go back to reference Burgio KL, Richter HE, Clements RH, et al.: Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 2007, 110:1034–1040.PubMed Burgio KL, Richter HE, Clements RH, et al.: Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol 2007, 110:1034–1040.PubMed
33.
go back to reference • Subak LL, Wing R, West DS, et al.: Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009, 360:481–490. This is a randomized controlled trial of 338 overweight and obese women with urinary incontinence randomized to an intensive weight-loss program and behavior modification or to a structured education program. Women in the weight-loss program lost significantly more weight after 6 months and had a significantly large decrease in the number of weekly incontinence episodes when compared to those in the education group.CrossRefPubMed • Subak LL, Wing R, West DS, et al.: Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med 2009, 360:481–490. This is a randomized controlled trial of 338 overweight and obese women with urinary incontinence randomized to an intensive weight-loss program and behavior modification or to a structured education program. Women in the weight-loss program lost significantly more weight after 6 months and had a significantly large decrease in the number of weekly incontinence episodes when compared to those in the education group.CrossRefPubMed
34.
go back to reference • Dumoulin C, Hay-Smith J: Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010, (1):CD005654. This Cochrane review of 12 trials (672 women) looks at the effects of pelvic floor muscle training for urinary incontinence compared to no treatment, placebo, or inactive control, which found fewer incontinence episodes as well as better quality of life in those undergoing pelvic floor muscle training as compared to control patients. • Dumoulin C, Hay-Smith J: Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010, (1):CD005654. This Cochrane review of 12 trials (672 women) looks at the effects of pelvic floor muscle training for urinary incontinence compared to no treatment, placebo, or inactive control, which found fewer incontinence episodes as well as better quality of life in those undergoing pelvic floor muscle training as compared to control patients.
35.
go back to reference • Sar D, Khorshid L: The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life. J Wound Ostomy Continence Nurs 2009, 36:429–435. This is a randomized controlled trial of 41 women with SUI or MUI randomized to pelvic floor muscle training for 8 weeks or no intervention. Those randomized to pelvic floor muscle training had significant differences in the 1-hour pad test, episodes of leakage on a 3-day voiding diary, and I-QOL scores after 8 weeks when compared to control patients.PubMed • Sar D, Khorshid L: The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life. J Wound Ostomy Continence Nurs 2009, 36:429–435. This is a randomized controlled trial of 41 women with SUI or MUI randomized to pelvic floor muscle training for 8 weeks or no intervention. Those randomized to pelvic floor muscle training had significant differences in the 1-hour pad test, episodes of leakage on a 3-day voiding diary, and I-QOL scores after 8 weeks when compared to control patients.PubMed
36.
go back to reference Hashim H, Abrams P: Pharmacological management of women with mixed urinary incontinence. Drugs 2006, 66:591–606.CrossRefPubMed Hashim H, Abrams P: Pharmacological management of women with mixed urinary incontinence. Drugs 2006, 66:591–606.CrossRefPubMed
37.
go back to reference Dmochowski RR, Davila GW, Zinner NR, et al.: Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. J Urol 2002, 168:580–586.CrossRefPubMed Dmochowski RR, Davila GW, Zinner NR, et al.: Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. J Urol 2002, 168:580–586.CrossRefPubMed
38.
go back to reference Kreder KJ Jr, Brubaker L, Mainprize T: Tolterodine is equally effective in patients with mixed incontinence and those with urge incontinence alone. BJU Int 2003, 92:418–421.CrossRefPubMed Kreder KJ Jr, Brubaker L, Mainprize T: Tolterodine is equally effective in patients with mixed incontinence and those with urge incontinence alone. BJU Int 2003, 92:418–421.CrossRefPubMed
39.
go back to reference • Bent AE, Gousse AE, Hendrix SL, et al.: Duloxetine compared with placebo for the treatment of women with mixed urinary incontinence. Neurourol Urodyn 2008, 27:212–221. This is a randomized, placebo-controlled, double-blind clinical trial looking at 588 women with MUI randomized to duloxetine, 80 mg daily, or placebo. Overall incontinence episodes frequency as well as stress and urge incontinence episode decreases were significantly greater with duloxetine when compared to placebo.CrossRefPubMed • Bent AE, Gousse AE, Hendrix SL, et al.: Duloxetine compared with placebo for the treatment of women with mixed urinary incontinence. Neurourol Urodyn 2008, 27:212–221. This is a randomized, placebo-controlled, double-blind clinical trial looking at 588 women with MUI randomized to duloxetine, 80 mg daily, or placebo. Overall incontinence episodes frequency as well as stress and urge incontinence episode decreases were significantly greater with duloxetine when compared to placebo.CrossRefPubMed
40.
go back to reference Debodinance P, Delporte P, Engrand JB, Boulogne M: Tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Eur J Obstet Gynecol Reprod Biol 2002, 105:49–58.CrossRefPubMed Debodinance P, Delporte P, Engrand JB, Boulogne M: Tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Eur J Obstet Gynecol Reprod Biol 2002, 105:49–58.CrossRefPubMed
41.
go back to reference Schrepferman CG, Griebling TL, Nygaard IE, Kreder KJ: Resolution of urge symptoms following sling cystourethropexy. J Urol 2000, 164:1628–1631.CrossRefPubMed Schrepferman CG, Griebling TL, Nygaard IE, Kreder KJ: Resolution of urge symptoms following sling cystourethropexy. J Urol 2000, 164:1628–1631.CrossRefPubMed
42.
go back to reference • Tahseen S, Reid P: Effect of transobturator tape on overactive bladder symptoms and urge urinary incontinence in women with mixed urinary incontinence. Obstet Gynecol 2009, 113:617–623. This article reviews telephone questionnaires completed by patients with SUI, stress-predominant MUI, and urge-predominant SUI who underwent transobturator sling for treatment. UUI was cured in 43% of patients, improved in 36%, and persistent in 21%. No patients with SUI alone preoperatively reported de novo UUI postoperatively.PubMed • Tahseen S, Reid P: Effect of transobturator tape on overactive bladder symptoms and urge urinary incontinence in women with mixed urinary incontinence. Obstet Gynecol 2009, 113:617–623. This article reviews telephone questionnaires completed by patients with SUI, stress-predominant MUI, and urge-predominant SUI who underwent transobturator sling for treatment. UUI was cured in 43% of patients, improved in 36%, and persistent in 21%. No patients with SUI alone preoperatively reported de novo UUI postoperatively.PubMed
43.
go back to reference Holmgren C, Nilsson S, Lanner L, Hellberg D: Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol 2005, 106:38–43.PubMed Holmgren C, Nilsson S, Lanner L, Hellberg D: Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol 2005, 106:38–43.PubMed
44.
go back to reference • Kulseng-Hanssen S, Husby H, Schiotz HA: Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:391–396. This is a retrospective review of 1113 women with MUI who underwent TVT, looking at outcomes in those with stress predominance, urge predominance, and equivalent stress and urge bother at 7 and 38 months. Those with stress predominance more often were dry during pad test, very satisfied, and objectively and subjectively cured when compared to those with urge predominance and equivalent bother; however, at 38 months, 60% and 73% of these patients, respectively, reported being very satisfied.CrossRefPubMed • Kulseng-Hanssen S, Husby H, Schiotz HA: Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:391–396. This is a retrospective review of 1113 women with MUI who underwent TVT, looking at outcomes in those with stress predominance, urge predominance, and equivalent stress and urge bother at 7 and 38 months. Those with stress predominance more often were dry during pad test, very satisfied, and objectively and subjectively cured when compared to those with urge predominance and equivalent bother; however, at 38 months, 60% and 73% of these patients, respectively, reported being very satisfied.CrossRefPubMed
45.
go back to reference Ankardal M, Heiwall B, Lausten-Thomsen N, et al.: Short- and long-term results of the tension-free vaginal tape procedure in the treatment of female urinary incontinence. Acta Obstet Gynecol Scand 2006, 85:986–992.CrossRefPubMed Ankardal M, Heiwall B, Lausten-Thomsen N, et al.: Short- and long-term results of the tension-free vaginal tape procedure in the treatment of female urinary incontinence. Acta Obstet Gynecol Scand 2006, 85:986–992.CrossRefPubMed
46.
go back to reference Chêne G, Amblard J, Tardieu AS, et al.: Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol 2007, 134:87–94.CrossRefPubMed Chêne G, Amblard J, Tardieu AS, et al.: Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol 2007, 134:87–94.CrossRefPubMed
47.
go back to reference Osman T: Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. BJU Int 2003, 92:964–968.CrossRefPubMed Osman T: Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. BJU Int 2003, 92:964–968.CrossRefPubMed
48.
go back to reference • Kenton K, Richter H, Litman H, et al.: Risk factors associated with urge incontinence after continence surgery. J Urol 2009, 182:2805–2809. This secondary analysis of data from the Stress Incontinence Surgical Treatment Efficacy trial, looking at risk factors for development of postoperative UUI after Burch colposuspension or autologous fascia sling, found that the odds were higher for development of postoperative UUI in those undergoing sling as well as those with prior anticholinergic use, preoperative DO, and higher MESA urge score.CrossRefPubMed • Kenton K, Richter H, Litman H, et al.: Risk factors associated with urge incontinence after continence surgery. J Urol 2009, 182:2805–2809. This secondary analysis of data from the Stress Incontinence Surgical Treatment Efficacy trial, looking at risk factors for development of postoperative UUI after Burch colposuspension or autologous fascia sling, found that the odds were higher for development of postoperative UUI in those undergoing sling as well as those with prior anticholinergic use, preoperative DO, and higher MESA urge score.CrossRefPubMed
49.
go back to reference Botros SM, Abramov Y, Goldberg RP, et al.: Detrusor overactivity and urge urinary incontinence [corrected] following midurethral versus bladder sling procedures. Am J Obstet Gynecol 2005, 193:2144–2148. (Published erratum appears in Am J Obstet Gynecol 2006, 194:595.)CrossRefPubMed Botros SM, Abramov Y, Goldberg RP, et al.: Detrusor overactivity and urge urinary incontinence [corrected] following midurethral versus bladder sling procedures. Am J Obstet Gynecol 2005, 193:2144–2148. (Published erratum appears in Am J Obstet Gynecol 2006, 194:595.)CrossRefPubMed
50.
go back to reference • 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, 19:123–129. This retrospective review of 144 women with MUI who underwent sling found that preoperative low maximum urethral closure pressure and DO both were associated with increased likelihood of treatment failure of UUI.PubMed • 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, 19:123–129. This retrospective review of 144 women with MUI who underwent sling found that preoperative low maximum urethral closure pressure and DO both were associated with increased likelihood of treatment failure of UUI.PubMed
51.
go back to reference • Brubaker L, Stoddard A, Richter H, et al.: Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn 2009, 28:268–273. This secondary analysis of data from the Stress Incontinence Surgical Treatment Efficacy trial attempts to define MUI with both the MESA score and bother based on the UDI. The definitions then were evaluated against the trial’s clinical outcomes, and the authors found that very little of the variability was explained by any of the MUI definitions tested.CrossRefPubMed • Brubaker L, Stoddard A, Richter H, et al.: Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn 2009, 28:268–273. This secondary analysis of data from the Stress Incontinence Surgical Treatment Efficacy trial attempts to define MUI with both the MESA score and bother based on the UDI. The definitions then were evaluated against the trial’s clinical outcomes, and the authors found that very little of the variability was explained by any of the MUI definitions tested.CrossRefPubMed
52.
go back to reference Doo CK, Hong B, Chung BJ, et al.: Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence. Eur Urol 2006, 50:333–338.CrossRefPubMed Doo CK, Hong B, Chung BJ, et al.: Five-year outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence. Eur Urol 2006, 50:333–338.CrossRefPubMed
53.
go back to reference Chou EC, Flisser AJ, Panagopoulos G, Blaivas JG: Effective treatment for mixed urinary incontinence with a pubovaginal sling. J Urol 2003, 170:494–497.CrossRefPubMed Chou EC, Flisser AJ, Panagopoulos G, Blaivas JG: Effective treatment for mixed urinary incontinence with a pubovaginal sling. J Urol 2003, 170:494–497.CrossRefPubMed
54.
go back to reference Trockman BA, Leach GE, Hamilton J, et al.: Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients. J Urol 1995, 154:1841–1847.CrossRefPubMed Trockman BA, Leach GE, Hamilton J, et al.: Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients. J Urol 1995, 154:1841–1847.CrossRefPubMed
Metadata
Title
Overactive Bladder and Mixed Incontinence
Authors
Sunshine Murray
Gary E. Lemack
Publication date
01-11-2010
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 6/2010
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-010-0146-0

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