Characteristics Associated With Treatment Failure 1 Year After Midurethral Sling in Women With Mixed Urinary Incontinence

摘要

Mixed urinary incontinence, including both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI), occurs in up to 50% of women with urinary incontinence. Mixed incontinence is often considered more severe and more difficult to treat than either urinary condition alone. Clinical guidelines that recommended treating SUI and UUI separately were largely based on older, currently uncommon surgical procedures and limited data. Guidelines have cautioned that surgery for the SUI component may worsen the urgency component. The ESTEEM (Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence) trial was a multicenter network study designed to determine among a population of women with mixed urinary incontinence whether use of perioperative behavioral and pelvic floor muscle therapy combined with midurethral sling surgery (combined treatment) would improve urinary symptoms at 12 months compared with sling alone. The trial data demonstrated that 85% of patients were overall "much better" or "very much better" after midurethral sling with or without behavioral and pelvic floor muscle therapy, with symptomatic movement in UUI symptoms. Worsening urgency at 12 months was reported by less than 5% of women.