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Stress Urinary Incontinence Management in the Patient With Overactive Bladder

  • Stress Incontinence and Prolapse (S Reynolds, Section Editor)
  • Published:
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Abstract

Purpose of the Review

Mixed urinary incontinence is a common diagnosis that has significant impact on patient quality of life and can be more bothersome to patients compared to pure stress incontinence. Given the complexity of concomitant stress incontinence and overactive bladder symptoms, mixed urinary incontinence can often present as a clinically challenging scenario for treating physicians across different subspecialties and primary care medicine. In this review, we discuss the importance of a judicious evaluation and the utility of deciphering stress-predominant versus urge-predominant urinary incontinence in patients with concomitant symptoms.

Recent Findings

The temporal relationship between stress incontinence and urgency symptoms has been explored in recent literature. Although a common pathway has been alluded, characterization of the predominant symptom is essential in treating this difficult diagnosis. As suggested in recent guidelines, emphasis should be placed on setting appropriate patient goals of care and discussing treatment expectations in order to best optimize patient satisfaction and patient-reported treatment success. Risks, benefits, and alternatives for both stress urinary incontinence and overactive bladder treatment options should be reviewed, yet there is lack of a standardized approach in the literature.

Summary

We outline a sequential algorithm to help guide patient counseling, management, and appropriate expectations for treatment of mixed urinary incontinence.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.

  2. Lee UJ, Scott VC, Rashid R, Behniwal A, Wein AJ, Maliski SL, et al. Defining and managing overactive bladder: disagreement among the experts. Urology. 2013;81:257–62.

  3. Chughtai B, Laor L, Dunphy C, Lee R, Te A, Diagnosis KS. Evaluation, and treatment of mixed urinary incontinence in women. Rev Urol. 2015;17:78–83.

    PubMed  PubMed Central  Google Scholar 

  4. • Minassian VA, Yan XS, Pitcavage J, Stewart WF. Mixed incontinence masked as stress induced urgency urinary incontinence. J Urol. 2016;196:1190–5. A recent study demonstrates the prevalence of each urinary incontinence subtype and reflects the striking temporal relationship between patient-reported stress incontinence episodes and urge uriniary incontinence.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Anger J, Rodriguez LV. Mixed incontinence: stressing about urge. Curr Urol Rep. 2004;5:427–31.

    Article  PubMed  Google Scholar 

  6. Chou EC, Blaivas JG, Chou LW, Flisser AJ, Panagopoulos G. Urodynamic characteristics of mixed urinary incontinence and idiopathic urge urinary incontinence. Neurourol Urodyn. 2008;27:376–8.

    Article  PubMed  Google Scholar 

  7. Minassian VA, Devore E, Hagan K, Grodstein F. Severity of urinary incontinence and effect on quality of life in women by incontinence type. Obstet Gynecol. 2013;121:1083–90.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Minassian VA, Stewart WF, Wood GC. Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol. 2008;111(2 Pt 1):324–31.

    Article  PubMed  Google Scholar 

  9. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000;53:1150–7.

    Article  PubMed  CAS  Google Scholar 

  10. Brubaker L, Stoddard A, Richter H, Zimmern P, Moalli P, Kraus SR, et al. Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009;28:268–73.

  11. Brubaker L, Lukacz ES, Burgio K, Zimmern P, Norton P, Leng W, et al. Mixed incontinence: comparing definitions in non-surgical patients. Neurourol Urodyn. 2011;30:47–51.

  12. Asoglu MR, Selcuk S, Cam C, Cogendez E, Karateke A. Effects of urinary incontinence subtypes on women’s quality of life (including sexual life) and psychosocial state. Eur J Obstet Gynecol Reprod Biol. 2014;176:187–90.

    Article  PubMed  Google Scholar 

  13. Chaliha C, Khullar V. Mixed incontinence. Urology. 2004;63(3 Suppl 1):51–7.

    Article  PubMed  Google Scholar 

  14. • Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU Guideline. J Urol. 2017;198:875–83. This is a very timely and recent review of the surgical treatment options for SUI, in which many principles may be transferable to a patient with mixed incontinence, particulary if the patient is a stress-predominant subtype.

    Article  PubMed  Google Scholar 

  15. Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366:1987–97.

  16. • Brucker BM. Expectations of stress urinary incontinence surgery in patients with mixed urinary incontinence. Rev Urol. 2015;17:14–9. This is a contemporary review that emphasizes the importance of educating the patient on various treatment options and appropriate counseling for mixed incontinence.

    PubMed  PubMed Central  Google Scholar 

  17. Winters JC, Dmochowski RR, Goldman HB, Herndon CD, Kobashi KC, Kraus SR, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2464–72.

    Article  PubMed  Google Scholar 

  18. Digesu GA, Salvatore S, Fernando R, Khullar V. Mixed urinary symptoms: what are the urodynamic findings? Neurourol Urodyn. 2008;27(5):372–5.

    Article  PubMed  Google Scholar 

  19. Katsumi HK, Rutman MP. Can we predict if overactive bladder symptoms will resolve after sling surgery in women with mixed urinary incontinence? Curr Urol Rep. 2010;11:328–37.

    Article  PubMed  Google Scholar 

  20. Schrepferman CG, Griebling TL, Nygaard IE, Kreder KJ. Resolution of urge symptoms following sling cystourethropexy. J Urol. 2000;164:1628–31.

    Article  PubMed  CAS  Google Scholar 

  21. Myers DL. Female mixed urinary incontinence: a clinical review. JAMA. 2014;311:2007–14.

  22. Dumoulin C, Hay-Smith J, Habée-Séguin GM, Mercier J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: a short version Cochrane systematic review with meta-analysis. Neurourol Urodyn. 2015;34:300–8.

    Article  PubMed  Google Scholar 

  23. Weber MA, Klejin MH, Langedam M, Limpens J, Heineman MJ, Roovers JP. Local oestrogen for pelvic floor disorders: a systematic review. PLoS One. 2015;10:e0136265. https://doi.org/10.1371/journal.pone.0136265.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. • Risacher SL, McDonald BC, Tallman EF, West JD, Farlow MR, Unverzaqt FW, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol. 2016;73:721–32. This study sheds light on the detrimental effects of anticholinergic medication for the treatment of overactive bladder in the elderly population nad the association of increased brain atrophy and dysfunction and clinical decline, suggesting that in the aged patient population, other modalities of treatment should be considered.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Khullar V, Hill S, Laval KU, Schiøtz HA, Jonas U, Versi E. Treatment of urge-predominant mixed urinary incontinence with tolterodine extended release: a randomized, placebo-controlled trial. Urology. 2004;64:269–74; discussion 274-5.

    Article  PubMed  Google Scholar 

  26. Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological Association, Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572–80.

    Article  PubMed  Google Scholar 

  27. Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.

  28. Lee EW, Kobashi KC. Mixed incontinence: what takes precedence in its management? Curr Urol Rep. 2014;15:461.

    Article  PubMed  Google Scholar 

  29. McLennan MT, Melick C, Bent AE. Urethral instability: clinical and urodynamic characteristics. Neurourol Urodyn. 2001;20:653–60.

    Article  PubMed  CAS  Google Scholar 

  30. Wise BG, Cardozo LD, Cutner A, Benness CJ, Burton G. Prevalence and significance of urethral instability in women with detrusor instability. Br J Urol. 1993;72:26–9.

    Article  PubMed  CAS  Google Scholar 

  31. Breyer BN, Phelan S, Hogan PE, Rosen RC, Kitabchi AE, Wing RR, et al. Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: results from the Look AHEAD trial. J Urol. 2014;192:144–9.

  32. Phelan S, Kanaya AM, Subak LL, Hogan PE, Espeland MA, Wing RR, et al. Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial. J Urol. 2012;187:939–44.

  33. Dumoulin C, Hay-Smith EJ, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD005654.pub3.

  34. Thor KB, Donatucci C. Central nervous system control of the lower urinary tract: new pharmacological approaches to stress urinary incontinence in women. J Urol. 2004;172:27–33.

    Article  PubMed  CAS  Google Scholar 

  35. Li J, Yang L, Pu C, Tang Y, Yun H, Han P. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis. Int Urol Nephrol. 2013;45:679–86.

    Article  PubMed  CAS  Google Scholar 

  36. Hunsballe JM, Djurhuus JC. Clinical options for imipramine in the management of urinary incontinence. Urol Res. 2001;29:118–25.

    Article  PubMed  CAS  Google Scholar 

  37. Toozs-Hobson P, Al-Singary W, Fynes M, Tegerstedt G, Lose G. Two-year follow-up of an open-label multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and stress-predominant mixed incontinence. Int Urogynecol J. 2012;23:1373–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Osman T. Stress incontinence surgery for patients presenting with mixed incontinence and a normal cystometrogram. BJU Int. 2003;92:964–8.

    Article  PubMed  CAS  Google Scholar 

  39. Kenton K, Richter H, Litman H, Lukacz E, Leng W, Lemack G, et al. Risk factors associated with urge incontinence after continence surgery. J Urol. 2009;182:2805–9.

  40. Jain P, Jirschele K, Botros SM, Latthe PM. Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2011;22:923–32.

    Article  PubMed  Google Scholar 

  41. Abdel-Fattah M, Ramsay I, Pringle S, Hardwick C, Ali H, Young D, et al. Evaluation of transobturator tension-free vaginal tapes in management of women with recurrent stress urinary incontinence. Urology. 2011;77(5):1070–5.

  42. Paick JS, Oh SJ, Kim SW, Ku JH. Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:123–9.

    Article  PubMed  Google Scholar 

  43. Lee JK, Dwyer PL, Rosamilia A, Lim YN, Polyakov A, Stav K. Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG. 2011;118:798–805.

    Article  PubMed  Google Scholar 

  44. Brubaker L, Norton PA, Albo ME, Chai TC, Dandreo KJ, Lloyd KL, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol 2011;205. 498:e1–6.

  45. Novara G, Artibani W, Barber MD, Chapple CR, Constantini E, Ficarra V, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol. 2010;58:218–38.

    Article  PubMed  Google Scholar 

  46. Ku JH. The management of neurogenic bladder and quality of life in spinal cord injury. BJU Int. 2006;98:739–45.

    Article  PubMed  Google Scholar 

  47. Pannek J, Bartel P, Gocking K. Clinical usefulness of the transobturator sub-urethral tape in the treatment of stress urinary incontinence in female patients with spinal cord lesion. J Spinal Cord Med. 2012;35:102–6.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hamid R, Khastqir J, Arya M, Patel HR, Shah PJ. Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders. Spinal Cord. 2003;41:118–21.

    Article  PubMed  CAS  Google Scholar 

  49. Sakalis VI, Floyd MS Jr, Caygill P, Price C, Hartwell B, Guy PJ, et al. Management of stress urinary incontinence in spinal cord injured female patients with a mid-urethral tape—a single center experience. J Spinal Cord Med. 2017; https://doi.org/10.1080/10790268.2017.1393190.

  50. Murphy AM, Bethoux F, Stough D, Goldman HB. Prevalence of stress urinary incontinence in women with multiple sclerosis. Int Neurourol J. 2012;16:86–90.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.

  52. Mahajan ST, Patel PB, Marrie RA. Under treatment of overactive bladder symptoms in patients with multiple sclerosis: an ancillary analysis of the NARCOMS patient registry. J Urol. 2010;183:1432–7.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Female Pelvic Floor Medicine & Reconstructive Surgery, Virginia Mason Medical Center, Buck Pavilion, 7th Floor, 1100 9th Avenue, Seattle, WA, 98101, USA

    Katherine Amin & Alvaro Lucioni

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  1. Katherine Amin
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  2. Alvaro Lucioni
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Correspondence to Katherine Amin.

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Dr. Lucioni and Dr. Amin declare that they have no conflicts of interests.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Stress Incontinence and Prolapse

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Amin, K., Lucioni, A. Stress Urinary Incontinence Management in the Patient With Overactive Bladder. Curr Bladder Dysfunct Rep 13, 111–117 (2018). https://doi.org/10.1007/s11884-018-0470-7

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