\nLast Updated: October 2018
\nCurrent definitions
\nMixed Urinary Incontinence : the complaint of involuntary leakage associated with urgency and also with physical exertion, effort sneezing or coughing ( 2).
\nControversies
\nAbout 30% of the women with incontinence have Mixed Urinary Incontinence (MUI), with the degree of bother in this group being higher than pure stress urinary incontinence (SUI) (3). In this perspective, this form of incontinence is important to crystallize in terms of diagnostic evaluation and treatment. Both of which have proven to be difficult for MUI.
\nThe term Mixed Urinary Incontinence implicates an equal presence of stress- and urge incontinence in every MUI patient. However, in daily practice patients most commonly present themselves with predominant stress (with the urge component on the background), or predominant urge with a stress component on the background. Looking at applicability of the term and implications for further treatment it seems better to define MUI with the predominant component (stress predominant MUI / urge predominant MUI).
\nThere still remains much controversy on the pathophysiological basis of MUI. Do patients have 2 separate phenomena (urge- and stress urinary incontinence); one affecting the bladder and causing urgency incontinence, and the other secondary to intrinsic urethral dysfunction causing stress incontinence, or can MUI be explained by one pathophysiologic process (4).
\nIn terms of diagnostic evaluation further analysis of novel diagnostic tests to differentiate predominant cause of incontinence in cases of MUI should be explored. For example the use of ambulatory urodynamics and development of less invasive tests such as bladder wall thickness (ultrasound)or pelvic floor muscle thickness (static MRI) measurements.
\nWith regard to treatment much focus has been put to treatment of the stress incontinence component in patients with MUI (slings and bulking agents are frequently used (5)d. However, there is only very limited evidence on treatment of the urge incontinence component with, for example, sacral neuromodulation or botulinum toxin injections. Therefore, exploring additional treatment options for women with MUI specifically focusing on the urgency component is of importance.
\nReferences
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