Mixed Incontinence Rx: More High-Quality Evidence Needed

A review of studies on mixed urinary incontinence revealed a pressing need for more randomized trials that focus on best practices for treatment. 

Pertinent Points

- More research is needed to determine diagnostic and treatment guidelines for women with mixed urinary incontinence.

- A review of 73 published articles revealed that few high-quality, randomized trials have been conducted on mixed urinary incontinence.

The review indicated that there is high-quality evidence for treating urinary incontinence tied to specific situations, but mixed incontinence has been overlooked by researchers. For example, there is strong evidence supporting weight loss as an effective treatment for urinary incontinence, traditional and mid-urethral slings and retropubic urethropexies for treating stress urinary incontinence, and managing urge urinary incontinence with anticholinergic medications.

Citing “a lack of direct, high-quality evidence for treating women with mixed urinary incontinence, as well as an absence of clear, diagnostic criteria and management guidelines for these patients,” Deborah L. Myers, MD, director of the Division of Urogynecology and Reconstructive Pelvic Surgery at Women & Infants Hospital of Rhode Island and The Warren Alpert Medical School of Brown University, Providence, urged more clinical trials to be conducted that would help establish better diagnostic and treatment guidelines.

“Because of this [lack of evidence], treatment usually begins with conservative management emphasizing the most bothersome component," Myers said in a news release.

Myers reviewed 73 published studies aimed at the prevalence, diagnosis, results, and treatment of mixed urinary incontinence. Her findings were published last month in the Journal of the American Medical Association.

Already, Myers and her colleagues have started to address the need for more studies and are recruiting patients for a national study comparing a midurethral sling alone or a midurethral sling combined with behavioral pelvic floor muscle therapy before and after surgery in women with mixed urinary incontinence. Vivian Sung, MD, MPH, of Women & Infants Hospital and the Alpert Medical School, is the principal investigator for the study.