Yung Kar Kei, Cheung Rachel Y K, Wan Osanna Y K, Lee Loreta L L, Choy Kwong W, Chan Symphorosa S C
Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Int Urogynecol J. 2023 Mar;34(3):665-673. doi: 10.1007/s00192-022-05097-6. Epub 2022 Apr 21.
Mixed urinary incontinence (MUI) is a common yet understudied condition. It remains a therapeutic challenge, with the presence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). There is limited information on the optimal management for women with urodynamic MUI (urodynamic stress incontinence and detrusor overactivity). We assessed the treatment outcome of pelvic floor muscle training (PFMT), medical treatment and surgery for women who were diagnosed with urodynamic MUI.
A prospective observational study was carried out on women with urodynamic MUI from 2010 to 2018. All women underwent clinical assessment and standardised urodynamic evaluation. All women received PFMT from a specialised continence advisor as initial management. Antimuscarinics and/or continence surgery were considered according to the woman's response and symptoms after PFMT. Subjective outcome after each treatment modality was analysed.
A total of 198 women were included for analysis. All women received PFMT, 104 (52.5%) showing improvement in urinary incontinence. Eighty-seven (43.9%) women were offered antimuscarinics, of whom 58 (29.3%) showed subjective improvement in both SUI and UUI, and 10 (5%) reported a reduction in UUI but persistent SUI. A total of 55 (27.7%) women received surgical treatment, with 20 receiving continence procedures. Sixteen out of twenty (80%) of them reported improvement in both SUI and UUI. None reported worsening of urgency or UUI. Overall, across all treatment modalities, 73.8% of women showed improvement in both SUI and UUI.
Future analyses can help to inform which patients will have a higher success rate after each treatment modality and help focus treatment effort on those with a high risk of persistent symptoms. This will provide relevant data in counselling women, giving reasonable expectations and directing the management of women with urodynamic MUI.
混合性尿失禁（MUI）是一种常见但研究不足的病症。由于同时存在压力性尿失禁（SUI）和急迫性尿失禁（UUI），它仍然是一个治疗难题。关于尿动力学MUI（尿动力学压力性尿失禁和逼尿肌过度活动）女性的最佳治疗方法，信息有限。我们评估了盆底肌训练（PFMT）、药物治疗和手术治疗对诊断为尿动力学MUI的女性的治疗效果。
对2010年至2018年诊断为尿动力学MUI的女性进行了一项前瞻性观察研究。所有女性均接受了临床评估和标准化尿动力学评估。所有女性均接受了来自专业尿失禁顾问的PFMT作为初始治疗。根据女性在PFMT后的反应和症状，考虑使用抗胆碱能药物和/或尿失禁手术。分析了每种治疗方式后的主观结果。
共有198名女性纳入分析。所有女性均接受了PFMT，其中104名（52.5%）尿失禁情况有所改善。87名（43.9%）女性使用了抗胆碱能药物，其中58名（29.3%）的SUI和UUI均有主观改善，10名（5%）报告UUI有所减轻但SUI持续存在。共有55名（27.7%）女性接受了手术治疗，其中20名接受了尿失禁手术。其中20名中的16名（80%）报告SUI和UUI均有改善。无人报告急迫性或UUI恶化。总体而言，在所有治疗方式中，73.8%的女性SUI和UUI均有改善。
未来的分析有助于明确每种治疗方式后哪些患者成功率更高，并有助于将治疗重点放在症状持续风险高的患者身上。这将为咨询女性提供相关数据，给出合理预期并指导尿动力学MUI女性的管理。
