Physical Therapy and Surgery Reduce Mixed Urinary Incontinence Symptoms

In women with mixed urinary incontinence, symptom reduction is significantly greater when behavioral and pelvic floor muscle therapy is combined with midurethral sling surgery compared with surgery alone in women with mixed urinary incontinence, but the difference may not be clinically important, according to a study published in the Sept. 17 issue of the Journal of the American Medical Association.

Vivian W. Sung, M.D., M.P.H., from the Alpert Medical School of Brown University in Providence, Rhode Island, and colleagues conducted a randomized trial involving women aged 21 years or older with moderate or severe stress and urgency urinary incontinence symptoms for at least three months. Patients were randomly assigned to either behavioral and pelvic floor muscle therapy combined with midurethral sling (209 women) or sling alone (207 women).

The researchers found a significant decrease in the Urogenital Distress Inventory (UDI) score in the combined group from 178.0 points at baseline to 30.7 points at 12 months; in the sling-only group, the UDI score decreased significantly from 176.8 to 34.5 points. The model-estimated between-group difference was −13.4 points (95 percent confidence interval, −25.9 to −1.0; P = 0.04), which did not meet the threshold for a minimal clinically important difference. In 10.2 percent of the participants, related and unrelated serious adverse events occurred.

"Future analyses can help inform which patients are at risk of having persistent symptoms after midurethral sling and help focus future treatment efforts on this high-risk group," the authors write.

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