Clinical review published in JAMA

June 6, 2014

Many women experience bothersome urine loss with laughing, coughing and sneezing (stress urinary incontinence) AND on their way to the bathroom (urge urinary incontinence). When women experience both types of urine leakage, their condition is called mixed urinary incontinence. It is estimated that 20 to 36 percent of women suffer from mixed urinary incontinence, which is challenging to diagnose and treat because symptoms vary and guidelines for treatment are not clear.

A clinical review entitled "Clinical Crossroads – Female Mixed Urinary Incontinence" by Deborah L. Myers, 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, has been published in the May 21, 2014 edition of the Journal of the American Medical Association (JAMA).

"Because mixed urinary incontinence involves both types of incontinence, it is difficult to treat. Our goal was to review the diagnosis and management of mixed urinary incontinence in , with a focus on current available evidence," said Dr. Myers.

Dr. Myers reviewed 73 published articles that discussed the prevalence, diagnosis, results, and treatment of mixed urinary incontinence. She found that there is high-quality evidence for treating urinary incontinence with weight loss, for treating with surgery, and for treating urge urinary incontinence with medications.

"However, there is 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. Because of this, treatment usually begins with conservative management emphasizing the most bothersome component," continued Dr. Myers. "There is a clear need for randomized trials in women with mixed urinary incontinence."

Women & Infants Hospital is currently a member of the Pelvic Floor Disorders Network (PFDN), a team of doctors and researchers from eight clinical research centers around the country funded by the National Institutes of Health to improve the level of knowledge about pelvic floor disorders such as an overactive bladder. Through research studies, the team will be able to identify the most effective ways to care for women.

Through their participation in the Pelvic Floor Disorders Network, Dr. Myers and her colleagues are currently recruiting patients for the ESTEEM Study – Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence. Vivian Sung, MD, MPH, of Women & Infants Hospital and the Alpert Medical School, is the principal investigator of this national study comparing two approaches for treating mixed (MUI) in women, a midurethral sling alone or a midurethral sling combined with behavioral muscle therapy before and after surgery.

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