15 GW3965 Debate Strategies

When discussing treatment of mixed incontinence one must remember that ��for treatment to be successful both the stress and urge components of the incontinence need to respond to the therapies.��10 Clinical Studies Anti-incontinence sling surgery is not always the first choice, or the correct choice, for the management of MUI. However anti-incontinence sling surgery does fit into the treatment algorithm for treatment of MUI. When considering when to offer surgical options for MUI and how to counsel patients about expectations after these procedures, we need to synthesize the available data; to do this we often group like patients and compare the outcomes across these groups. A good example of some of the earliest work that attempted to understand selleck screening library outcomes of anti-incontinence procedures in the MUI population looked at women treated with autologous fascial bladder neck slings. The study used urodynamic parameters (in this case, videourodynamics) Adenine to predict outcomes. Although this work may be outdated because of the sling type, it illustrates observations that have helped clinicians manage patient expectations. The study ultimately looked at 70 patients with the complaint of urge who also had SUI (abdominal leak point pressure Target Selective Inhibitor Library The conclusion was that the patients with low-pressure motor urge had the highest success rate of symptom resolution after treatment with a bladder neck sling (91.3%) and had a complete continence rate of 82.6%. This concept of identifying preoperative predictors of success in the MUI population was also performed in a secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr).12 The authors looked at preoperative questionnaires to predict outcomes. The study included patients with predominant SUI and randomized them to Burch colposuspension versus autologous fascia pubovaginal sling (PVS). The odds ratio of having postoperative urgency urinary incontinence (UUI) was 4.14 (95% confidence interval [CI], 2.40�C7.15) for each 10-unit increase in Medical, Epidemiologic and Social Aspect of aging (MESA) urge score. Prior anticholinergic therapy and the presence of detrusor overactivity (DO) on urodynamic studies (UDS) were also preoperative predictors of postoperative UUI symptoms and initiation of treatment for UUI at 6-week follow-up. From this same study, published 2-year data showed that women with higher preoperative urge scores actually had higher SUI-specific failure, in addition to higher overall failure rates (4�� higher failure per 10 points on MESA).