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

Abstract

Objective: Our purpose was to determine if women with mixed urinary incontinence (MUI) and urodynamic detrusor overactivity (DO) have less improvement in urinary symptoms after pubovaginal sling surgery (PVS), compared to MUI without DO. Materials and Methods: Women with preoperative MUI symptoms prior to PVS were identified through retrospective review. DO was defined as a symptomatic 5 cm H 2 0 detrusor pressure or greater rise during urodynamics. MUI patients with and without DO before PVS were divided into Groups A and B, respectively. All patients had returned a completed Urogenital Distress Inventory 6 (UDI-6) questionnaire and a 3-day diary of pad usage before surgery and at each postoperative visit. Study endpoints included change in total UDI-6 score, and change in number of pad use/day after PVS. Results: 73 patients were identified, 31 in Group A and 42 in Group B. Mean follow-up after PVS was 15 and 16 months, respectively (p = 0.59). Preoperative total UDI-6 scores were 11.8 and 12.7 (p = 0.30) for Group A and B. Mean changes in total UDI-6 after PVS were -8.0 and -10.2 (p = 0.030), respectively. After PVS, both groups reported similar mean reduction in pad/day usage from preoperative baseline (-2.57 vs. --2.49, p = 0.83). There were no differences between the groups when comparing demographic, urodynamic, or operative data. Conclusion: MUI patients had improved continence and quality of life after PVS. However, MUI patients with DO had less improvement in UDI-6 scores after PVS, despite a similar reduction to pad use/day.

Does the Incidence of Urgency Symptoms Increase Along with the Severity of Stress Urinary Incontinence?

“…However, in real practice, only about 50% at most of women with MUI exhibited DO during urodynamics, which suggests that the urgency symptoms in MUI were closely linked with each other. In a preoperative urodynamic study of women with MUI, Stoffel et al reported that 42% of MUI patients had preoperative DO [25]. In our study, it was observed that 49.4% of MUI patients exhibited DO, which is similar to the report of Stoffel et al, but lower than that of Lewis et al, who insisted that 56% of SUI patients showed DO [26].…”

Urinary Oxidative Stress Biomarkers in the Diagnosis of Detrusor Overactivity in Female Patients with Stress Urinary Incontinence

“…However, an unneglectable portion of asymptomatic patients with coexisting DO and urodynamic urinary incontinence (USI) before anti-incontinence surgery has been reported [1]. Although DO does not preclude anti-incontinence surgery and patients with DO and SUI still have improved quality of life after a sling operation, the lesser degree of symptom improvement or even the risk of persistent urgency after the surgery still bothers patients with coexisting DO and mixed urinary incontinence [2,3]. Hence, identifying DO has an essential role in the preoperative evaluation [4].…”

Mixed urinary incontinence- what should we treat first?

“…The demonstration of detrusor overactivity in women with mixed incontinence has been reported to be between 11-56%. [46][47][48] Other publications have looked more specifically at the urodynamics of patients with urge or stresspredominant MUI.…”