Editor: Kevin Rademakers
Last Updated: October 2018
Current definitions
Mixed Urinary Incontinence : the complaint of involuntary leakage associated with urgency and also with physical exertion, effort sneezing or coughing ( 2).
Controversies
About 30% of the women with incontinence have Mixed Urinary Incontinence (MUI), with the degree of bother in this group being higher than pure stress urinary incontinence (SUI) (3). In this perspective, this form of incontinence is important to crystallize in terms of diagnostic evaluation and treatment. Both of which have proven to be difficult for MUI.
The term Mixed Urinary Incontinence implicates an equal presence of stress- and urge incontinence in every MUI patient. However, in daily practice patients most commonly present themselves with predominant stress (with the urge component on the background), or predominant urge with a stress component on the background. Looking at applicability of the term and implications for further treatment it seems better to define MUI with the predominant component (stress predominant MUI / urge predominant MUI).
There still remains much controversy on the pathophysiological basis of MUI. Do patients have 2 separate phenomena (urge- and stress urinary incontinence); one affecting the bladder and causing urgency incontinence, and the other secondary to intrinsic urethral dysfunction causing stress incontinence, or can MUI be explained by one pathophysiologic process (4).
In terms of diagnostic evaluation further analysis of novel diagnostic tests to differentiate predominant cause of incontinence in cases of MUI should be explored. For example the use of ambulatory urodynamics and development of less invasive tests such as bladder wall thickness (ultrasound)or pelvic floor muscle thickness (static MRI) measurements.
With regard to treatment much focus has been put to treatment of the stress incontinence component in patients with MUI (slings and bulking agents are frequently used (5)d. However, there is only very limited evidence on treatment of the urge incontinence component with, for example, sacral neuromodulation or botulinum toxin injections. Therefore, exploring additional treatment options for women with MUI specifically focusing on the urgency component is of importance.
References
- Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. NeurourolUrodyn. 2002;21(2):167-78.
- Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. NeurourolUrodyn. 2011;30(1):2-12.
- Dooley Y, Lowenstein L, Kenton K, FitzGerald M, Brubaker L. Mixed incontinence is more bothersome than pure incontinence subtypes. IntUrogynecol J Pelvic Floor Dysfunct. 2008;19(10):1359-62.
- Murray S, Lemack GE. Overactive bladder and mixed incontinence. Current urology reports. 2010;11(6):385-92.
- Chughtai B, Hauser N, Anger J, Asfaw T, Laor L Mao J et al. Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence. NeurourolUrodyn. 2017;36(2):422-425