Mixed Incontinence: What Takes Precedence in Its Management?

Lee, Eugene W.; Kobashi, Kathleen C.

doi:10.1007/s11934-014-0461-y

Cited by 12 publications

(8 citation statements)

References 47 publications

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“…However, because beta-3 agonists are effective for OAB, it is inferred that they would exhibit the same effectiveness as anticholinergics for mixed urinary incontinence. 56 Further evidence needs to be gathered going forward (Level 5; recommendation Grade C).…”

Section: Cq14 Do Therapeutic Drugs For Oab Affect Cognitive Function?mentioning

confidence: 99%

Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)

Takahashi¹,

Takei²,

Asakura³

et al. 2021

Int J of Urology

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The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.

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Section: Cq14 Do Therapeutic Drugs For Oab Affect Cognitive Function?mentioning

confidence: 99%

Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)

Takahashi¹,

Takei²,

Asakura³

et al. 2021

Int J of Urology

View full text Add to dashboard Cite

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“…While an attempt was made to conduct a randomized clinical trial evaluating initial OAB therapy or surgical therapy, the trial failed to recruit patients, so there is no high-level evidence supporting this approach. 2 However, secondary analysis of pooled, randomized, placebo-controlled trials for OAB have demonstrated that a significant proportion of women with urge predominant mixed urinary incontinence have complete resolution of their incontinence. 19 This suggests that either these patients were incorrectly classified as mixed incontinence (despite the rigorous assessment that goes along with a clinical trial), or that the etiology of the stress incontinence component of some women's mixed symptoms responds to anticholinergic therapy (for example, the case of stress induced DO).…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

“…20 Other medical options include the off-label use of imipramine (a tricyclic antidepressant) or duloxetine (a serotonin and norepinephrine reuptake inhibitor). 2 Likely the results of anticholinergic therapy in this population can be applied to beta-3 agonists.…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

“…1 It seems to be more common in older women and it has a greater impact on a woman's quality of life compared to pure urgency or stress incontinence. 2 The etiology of mixed incontinence may be due to two independent pathologies (bladder dysfunction and an incompetent urethral sphincter mechanism), or due primarily to an incompetent sphincter, which allows urine into the proximal urethral, causing both traditional stress incontinence at times, as well as reflexive detrusor contractions and urgency incontinence. 3,4 A recent study of women with mixed urinary incontinence who completing a 30-day enhanced bladder diary found that stress-induced urgency incontinence was actually the most common pattern seen among their incontinence episodes.…”

Section: Introductionmentioning

confidence: 99%

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The management of mixed urinary incontinence in women

Welk¹,

Baverstock²

2017

CUAJ

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Mixed urinary incontinence is a common diagnosis among women with urinary leakage and is often present in women who are unable to characterize their incontinence. Research and optimized clinical treatment of these patients is limited by the challenges in objectively defining and stratifying this population. The evaluation of these patients should follow the same general principles as any assessment of any women with incontinence; however, it is essential to define whether urge or stress incontinence is the predominant symptom. Urodynamics (UDS) may be helpful in this regard and may help predict surgical outcomes. Behavioural therapy, weight loss, and pelvic floor muscle therapy are usually appropriate initial management strategies. In postmenopausal women, vaginal estrogen can be considered, and in women with equal parts stress and urge incontinence or urge-predominant mixed incontinence, a trial of anticholinergics or beta-3 agonists is appropriate. In women with stress-predominant or equal parts stress and urge incontinence, stress incontinence surgery can be considered, with the caveat that outcomes are generally worse among women with more severe levels of urgency, success rates may not be as durable, and a significant proportion of women may need additional medical therapy.

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“…If the UUI component is equally as bothersome as the SUI component (as reported by the patient in our scenario), primary treatment of UUI symptoms has been recommended. 15 There is good evidence supporting the use of medications in the first instance; for example, the anticholinergic drugs solifenacin, 16 tolterodine 17 and transdermal oxybutynin, 18 as well as the recently introduced beta3 agonist mirabegron, 19 are all known to be safe, effective and well-tolerated in patients with MUI. When medical therapy is ineffective, intravesicular injection of onabotulinumtoxinA is safe, significantly improves symptoms for 6–12 months and can be repeated.…”

Section: Should the Urge Urinary Incontinence Be Treated First?mentioning

confidence: 99%

Mixed urinary incontinence- what should we treat first?

Khoo

Kujawa

Reid

et al. 2017

Journal of Clinical Urology

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Mixed urinary incontinence (MUI) is defined as 'the involuntary loss of urine associated with urgency and also with effort or physical exertion, or on sneezing or coughing'. It is highly prevalent, increases with age and affects women more than men. It has a significant negative impact on health-related quality of life (HRQL). Additionally, treatment of mixed urinary incontinence places a large financial burden on both individuals and the NHS. Optimal management of this common condition is contested-should we treat the urge urinary incontinence (UUI), stress urinary incontinence (SUI) or predominant symptom first? At the 2015 BAUS Section of Female, Neurological and Urodynamic Urology this subject was debated. Based on a common scenario, the authors of the debate present the arguments for treating the urge urinary incontinence component, stress urinary incontinence component or the predominant symptom of mixed urinary incontinence first, before making recommendations for current practice.

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Mixed Incontinence: What Takes Precedence in Its Management?

Cited by 12 publications

References 47 publications

Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)

Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)

The management of mixed urinary incontinence in women

Mixed urinary incontinence- what should we treat first?

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