In women with mixed urinary incontinence, a combined conservative and surgical treatment approach provided significant improvements versus surgical treatment alone, according to results of a randomized clinical trial.
Compared to women who received midurethral sling alone, women who received the sling plus perioperative behavioral/pelvic floor exercise had improved quality of life and decreased need for retreatment at 12 months, it was reported at the International Continence Society annual meeting in Philadelphia.
The improvements in incontinence symptoms, while statistically significant, did not meet prespecified criteria that would suggest a clinically important difference, meaning that a combined approach could not be recommended across the board, researcher Vivian W. Sung, MD, MPH, of Brown University, Providence, RI said in an interview.
“Secondary endpoints, including retreatment rates and quality of life, were significantly better in the combined group compared to the sling-only group, so our recommendation is that these findings should be discussed with patients, and treatment should be tailored based on their input and their preferences,” said Dr. Sung.
The report by Dr. Sung and colleagues, which received the Conservative Management Award at the ICS meeting, was based on 464 participants included in the primary intention-to-treat analysis of the ESTEEM study, including 235 randomly assigned to the combined approach, and 229 to sling only.
Patients in ESTEEM had mixed urinary incontinence, defined as stress and urgency incontinence symptoms that were at least moderately bothersome. They all underwent retropubic or transobturator midurethral sling operations.
Behavioral/pelvic floor therapy sessions were conducted by trained interventionists, starting 1 month before and ending 6 months after the procedure.The standardized intervention included education on voiding habits, pelvic floor muscle and bladder training, and strategies to control urgency and reduce or prevent urinary symptoms.
Patients receiving the sling and intervention had significantly improved mixed urinary incontinence symptoms based on total Urogenital Distress Inventory (UDI) score at 12 months, the primary end-point of the study.
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