From the Research
Approximately 60.7% of patients with mixed urinary incontinence will experience improvement in urinary urgency and urgency incontinence after a mid urethral sling procedure, according to the most recent and highest quality study 1. This study, published in 2023, investigated the success rates and predictive factors for midurethral slings in women with mixed urinary incontinence. The results showed that the overall mixed urinary incontinence cure rate was 73.5%, but the surgical success rate in the presence of postoperative urgency was 60.7%. The improvement in urgency symptoms after a mid urethral sling procedure may be related to several factors, including decreased urethral hypermobility, reduced urethral irritation from urine leakage, or changes in bladder sensation pathways following the procedure. However, the study also found that preoperative OAB-V8 score, symptom duration >9.5 years, and preoperative anticholinergic medication were risk factors for persistent urgency and urgency urinary incontinence postoperatively. Some key points to consider when counseling patients with mixed urinary incontinence who are considering a mid urethral sling procedure include:
- The primary indication for the sling remains stress incontinence, and some patients may require additional treatments to fully address their urgency component.
- The greatest improvements tend to occur in patients whose mixed incontinence is predominantly stress-related rather than urgency-predominant.
- Patients with a high OAB-V8 score, symptom duration >9.5 years, diabetes mellitus, or use of anticholinergic medication preoperatively may not be good candidates for a mid urethral sling procedure. It's also worth noting that the study found that midurethral sling success rate was 84.8% in those with preoperative stress-dominant mixed urinary incontinence, but the success rates for equally and urgency-dominant mixed urinary incontinence were both 29.4% 1. Overall, the decision to proceed with a mid urethral sling procedure should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and treatment goals.