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Female Mixed Urinary Incontinence: Urodynamic Parameters And Udi-6 Scores In Patients Undergoing Distal Urethral Polypropylene Sling
Paholo G. Barboglio Romo, MD, MPH1, Veronica Triaca, MD2.
1Dartmouth-Hitchcock, Lebanon, NH, USA, 2Urology-FPMRS, Concord, NH, USA.

BACKGROUND: Mixed urinary incontinence (MUI) accounts for 22%-55% female incontinence and remains relatively under-investigated in the literature. Our objective was to describe the urodynamic findings and self-reported symptoms in a cohort of women with a presenting diagnosis of MUI undergoing distal urethral polypropylene sling (DUPS).

METHODS: An IRB approved retrospective review of a cohort of 275 women who underwent DUPS from October 2008 to January 2011. Self-reported validated questionnaire (UDI-6) and urodynamic (UDS) data was analyzed. UDI-6 total score was calculated (range 0-100). Women were identified and evaluated with UDS for complaints of MUI assessed during the initial history and physical examination. The pertinent clinical parameters in making the UDS diagnosis of MUI were reviewed, including the presence (+) or absence (-) of stress incontinence during UDS (U-SUI), and detrusor overactivity (DO). Continuous data were analyzed using student's t-test and ANOVA. Categorical data via the Pearson Chi Square test.

RESULTS: The diagnosis of MUI was found in 183/275 patients and complete data at one year follow up was available for 157 (86%) patients. Mean age was 59 years (23-87). When assessing UDS findings, 81/157 (52%) were found to have evidence of U-SUI and 33/157 (21%) with DO+. DO and SUI were both present in 13.3% of patients studied. Further, mean cystometric capacity (MCC) was different among the groups with the lowest trend in the group with both the presence of U-SUI and DO (p<0.001). There was no difference between groups' pre-operative and post-operatively UDI-6 scores (Table). However, UDI-6 total scores at one year improved significantly from baseline in all groups (p<0.05). Patients with both U-SUI and DO appear to have the greatest significant improvement in symptoms.

CONCLUSIONS: We conclude that in this cohort of patients undergoing DUPS for MUI, urodynamic evidence of MUI is present 13% of the time. These women have the greatest potential for improvement in urinary symptoms at 1 year.
UDI-6 total scores
Pre-opPre-operativePost-opPost-operative
U-SUI (+)U-SUI (-)U-SUI (+)U-SUI (-)
DO (+)7454DO (+)1411
DO (-)5754DO (-)1416
p value0.3170.491


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