Editorial Comment: Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery vs Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence: The ESTEEM Randomized Clinical Trial

Abstract

The use of physical therapy has been strongly recommended in the most popular guidelines regarding stress urinary incontinence (1) and overactive bladder (2). In this interesting article published in JAMA, the authors presented a prospective randomized study that sought to evaluate whether performing a mid-urethral sling combined with behavioral therapy and 6 pelvic floor muscle training (PFMT) sessions (n: 209) would yield better outcomes compared to exclusive mid-urethral sling implant (n: 207) in patients with mixed urinary incontinence. Patients were evaluated by the long-form Urogenital Distress Inventory (UDI), and the primary outcome was defined as significant improvement over the baseline condition after 12 months post treatment. In the group that performed the behavioral plus TMAP plus sling, the UDI