To review the functional results of the midurethral sling (MUS) in the management of mixed urinary incontinence (MUI) and provide guidance on patient selection and the potential benefits of concomitant treatments.
A literature review from the past 20 years was conducted from the PubMed database using the terms "mixed urinary incontinence," associated to "sling," "midurethral sling," "suburethral sling," "mid-urethral sling," "sub-urethral sling," and "tension-free vaginal tape".
The efficacy of the MUS varies considerably depending on the definition of success used. Stress urinary incontinence resolved in 78 to 100% of patients while urge urinary incontinence (UUI) resolved in 57.4 to 82% of patients at short-term follow up. Overall urinary incontinence (UI) resolved in 58% to 85% during this time. A significant proportion of women report a high degree of satisfaction with this treatment. Long-term studies with follow-up period greater than 36 months revealed a deterioration of the functional outcomes, especially for UUI. Older women with predominant UUI or detrusor overactivity on urodynamics may be at risk for poorer outcomes. Among concomitant treatments studied, OnabotulinumtoxinA injection, ospemifene, physiotherapy, percutaneous tibial nerve stimulation and surgical bladder denervation appears to offer benefits in improving UI. However, the evidence is currently insufficient to recommend their routine concomitant use.
MUS is an effective treatment for MUI. Further research is needed to better understand the potential benefits of concurrent treatments and to develop models that can predict outcomes and assist physicians in shared decision making about how to approach the management of MUI.
The French journal of urology. 2024 Nov 11 [Epub ahead of print]
Sonia Guérin, Christine Herforth, Maude Carmel
Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA; Department of Gynecology Obstetrics, Rennes University Hospital, Rennes, France., Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA., Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA. Electronic address: .