Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
JAMA. 2014 May 21;311(19):2007-14. doi: 10.1001/jama.2014.4299.
Mixed urinary incontinence, a condition of both stress and urge urinary incontinence, is prevalent in 20% to 36% of women and is challenging to diagnosis and treat because urinary symptoms are variable and guidelines for treatment are not clear.
To review the diagnosis and management of mixed urinary incontinence in women, with a focus on current available evidence.
MEDLINE was searched from January 1, 1992, to December 31, 2013. Additional citations were obtained from references of the selected articles and reviews. Articles that discussed the prevalence, diagnosis, results, and treatment of mixed urinary incontinence were selected for review. Evidence was graded using Oxford Centre for Evidence-Based Medicine levels of evidence for treatment recommendations.
The MEDLINE search resulted in 785 articles. After selection and obtainment of additional citations, a total of 73 articles were reviewed. There is high-quality (level 1) evidence for treating urinary incontinence with weight loss, for treating stress urinary incontinence by performing anti-incontinence procedures of both traditional and mid-urethral slings and retropubic urethropexies, and for managing urge urinary incontinence with anticholinergic medications. However, direct high-quality evidence for treatment of women with mixed urinary incontinence is lacking, as are clear diagnostic criteria and management guidelines.
High-quality, level 1 evidence for urinary incontinence therapy can guide clinicians in the treatment of the components of mixed urinary incontinence. Because high-quality evidence is lacking regarding the treatment of mixed urinary incontinence, treatment generally begins with conservative management emphasizing the most bothersome component. Randomized trials in women with mixed urinary incontinence populations are needed.
混合性尿失禁（同时存在压力性和急迫性尿失禁的一种病症）在 20%至 36%的女性中较为普遍，其诊断和治疗具有挑战性，因为尿失禁症状具有多变性，且治疗指南尚不明确。
回顾女性混合性尿失禁的诊断和管理，重点关注当前可用的证据。
从 1992 年 1 月 1 日至 2013 年 12 月 31 日，对 MEDLINE 进行了检索。从选定的文章和综述的参考文献中获得了额外的引文。选择讨论混合性尿失禁的流行率、诊断、结果和治疗的文章进行综述。使用牛津循证医学中心的证据分级系统对治疗建议的证据进行分级。
MEDLINE 检索结果有 785 篇文章。经过筛选和进一步获取引文，共综述了 73 篇文章。有高质量（1 级）证据表明，减轻体重可治疗尿失禁，进行传统和中尿道吊带及耻骨后尿道悬吊术的抗失禁手术可治疗压力性尿失禁，抗胆碱能药物可治疗急迫性尿失禁。然而，缺乏针对混合性尿失禁女性的直接高质量证据，也缺乏明确的诊断标准和管理指南。
高质量、1 级证据可指导临床医生治疗混合性尿失禁的各个组成部分。由于缺乏关于混合性尿失禁治疗的高质量证据，治疗通常从强调最令人困扰的症状的保守管理开始。需要在混合性尿失禁人群中进行随机试验。
