Department of Urology, CHU Rangueil, Toulouse, France.
Department of Urology, Vanderbilt University, Nashville, Tennessee, USA.
Neurourol Urodyn. 2023 Feb;42(2):401-408. doi: 10.1002/nau.25065. Epub 2022 Oct 23.
The aim of this debate article is to discuss whether effective treatments are available for mixed urinary incontinence (MUI). Because patients with MUI have both stress and urgency urinary incontinence (SUI and UUI) episodes and current treatment guidelines currently recommend treating the predominant symptom first, this article presents standard and emerging treatments for both SUI and UUI before discussing how well these treatments meet the medical needs of patients with MUI. Standard treatments presented include noninvasive options such as lifestyle changes and pelvic floor exercises, pharmacological agents, and surgery. Treatment of all three types of urinary incontinence (UI) is usually initiated with noninvasive options, after which treatment options diverge based on UI subtype. Multiple pharmacological agents have been developed for the treatment of UUI and overactive bladder, whereas surgery remains the standard option for SUI and stress-predominant MUI. The divide between UUI and SUI options seems to be propagated in emerging treatments, with most novel pharmacological agents still targeting UUI and even having SUI and stress-predominant MUI as exclusion criteria for participation in clinical trials. Considering that current treatment options focus almost exclusively on treating the predominant symptom of MUI and that emerging pharmacological treatments exclude patients with stress-predominant MUI during the development phase, effective treatments for MUI are lacking both in standard and emerging practice. Ideally, agents with dual mechanisms of action could provide symptom benefit for both the stress and urgency components of MUI.
本文旨在探讨混合性尿失禁(MUI)是否存在有效的治疗方法。由于 MUI 患者既有压力性尿失禁(SUI)又有急迫性尿失禁(UUI)发作,且目前的治疗指南建议首先治疗主要症状,因此本文在讨论这些治疗方法在多大程度上满足 MUI 患者的医疗需求之前,先介绍了 SUI 和 UUI 的标准和新兴治疗方法。本文介绍的标准治疗方法包括生活方式改变和骨盆底运动等非侵入性选择、药物治疗以及手术。所有三种类型的尿失禁(UI)的治疗通常都从非侵入性选择开始,然后根据 UI 亚型选择不同的治疗方法。已经开发出多种药物治疗 UUI 和膀胱过度活动症,而手术仍然是 SUI 和以压力为主的 MUI 的标准治疗选择。UUI 和 SUI 治疗方法之间的差异似乎在新兴治疗方法中进一步扩大,大多数新型药物仍针对 UUI,甚至将 SUI 和以压力为主的 MUI 作为临床试验参与的排除标准。考虑到目前的治疗选择几乎完全专注于治疗 MUI 的主要症状,并且在开发阶段新兴的药物治疗将以压力为主的 MUI 患者排除在外,MUI 的标准和新兴治疗方法都缺乏有效的治疗方法。理想情况下,具有双重作用机制的药物可以为 MUI 的压力和急迫性成分提供症状改善。