Mixed incontinence patients show low risk for needing SUI surgery

May 13, 2020

Women with mixed urinary incontinence seeking surgical intervention for refractory urinary urge incontinence have the same low risk of subsequently needing surgery for stress urinary incontinence whether they are treated with intradetrusor onabotulinumtoxinA (BTX [Botox]) injections or sacral neuromodulation.

Women with mixed urinary incontinence (MUI) seeking surgical intervention for refractory urinary urge incontinence (UUI) have the same low risk of subsequently needing surgery for stress urinary incontinence (SUI) whether they are treated with intradetrusor onabotulinumtoxinA (BTX [Botox]) injections or sacral neuromodulation (SNM), researchers from Baylor Scott & White Health, in Dallas, Texas, reported at the American Urological Association 2020 Virtual Experience.

Having a history of medication-dependent diabetes mellitus or hysterectomy, however, may increase the likelihood of progression to SUI surgery, she reported.

“Treatment options for patients with MUI generally address SUI or UUI, but not both. Therefore, the approach to treating MUI usually considers whether the SUI or UUI is most bothersome, but then patients can have concerns about the ongoing course of the untreated condition and how it might be impacted by the treatment they select,” said Kim H. Thai, MD, a urology resident at Baylor Scott & White Health working with Jill Danford, MD, and colleagues.

“Although the outcomes of patients with MUI who are treated for SUI have been well studied, the need to intervene for SUI-related symptoms after surgical treatment for UUI has not. Our research provides information that physicians can share when counseling patients with MUI who are candidates for UUI surgery.”

Characterization of the effect of SNM and BTX on the SUI component of MUI was investigated in a retrospective study that identified adult women with MUI who underwent surgical treatment for UUI between January 2013 and June 2019. Patients with possible concomitant use of the 2 modalities and those with neurogenic bladder were excluded.

A total of 56 women treated with SNM and 40 receiving BTX injections were included in the analyses. The 2 groups were similar with respect to median age and body mass index.

After a median follow-up of approximately 1 year in both groups, only 8 women (9.1%) underwent SUI surgery, including 3 women in the BTX group (7.5%) and 5 women receiving SNM (8.9%). Type of UUI treatment (BTX vs SNM) was not associated with need for SUI surgery. Body mass index, smoking history, age, prior SUI therapies, and urodynamic stress incontinence were also not associated with SUI surgery. Medication-dependent diabetes (38% vs 5.6%, P = .02) and a history of hysterectomy (88% vs 39%, P = .02) were associated with SUI surgery following therapy for refractory UUI.

Thai noted that study limitations include its retrospective design and small sample size. “This study doesn’t capture women who had a persistent stress component of their SUI and pursued conservative therapies such as pelvic floor therapy or vaginal inserts. Prospective studies of MUI patients who have treatment for refractory UUI would help capture presence or absence of persistent stress incontinence,” she said.