A recent randomized clinical trial found that a procedure called mid-urethral sling surgery might help women who have both stress urinary incontinence and urgency urinary incontinence, together called mixed urinary incontinence. 

Stress urinary incontinence occurs when urine leaks out after abdominal pressure increases following a sneeze, cough, laugh, or other movement that squeezes the bladder. Urgency urinary incontinence results from the spontaneous contraction of bladder muscles, leading to a strong, sudden need to urinate. Many women with urinary incontinence have the mixed type.

Mid-urethral sling surgery is a well-established procedure in which doctors place a thin strip of mesh under the urethra to prevent urine from leaking out during an exertion. This technique was used in the study called Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM).

The ESTEEM trial tested whether perioperative behavioral and pelvic floor muscle therapy combined with mid-urethral sling surgery would improve mixed urinary incontinence symptoms at 12 months compared with sling alone. Mid-urethral sling surgery is usually recommended for women with stress urinary incontinence alone, but ESTEEM researchers found that it was of benefit to patients with mixed urinary incontinence as well.

ESTEEM investigators also found that the addition of perioperative behavioral and pelvic floor muscle therapy to mid-urethral sling treatment did not improve incontinence symptoms over sling alone at 12 months. Combined therapy may result in greater reductions in incontinence episodes, fewer additional urinary treatments, and an improved urinary incontinence-specific quality of life.

The study findings were reported in a recent issue of JAMA: The Journal of the American Medical Association and challenge current clinical protocols for mixed urinary incontinence. Current guidelines recommend treating the two forms of incontinence independently and suggest that surgery may worsen symptoms of urgency urinary incontinence in women with both forms.

The ESTEEM study was coordinated by the Pelvic Floor Disorders Network of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and co-funded by the NIH Office of Research on Women’s Health (ORWH) and NICHD.

Reference
Sung et al. 2019. JAMA doi: 10.1001/jama.2019.12467.