Surgery may benefit women with two types of urinary incontinence

Health News

Sharing is caring!

New Delhi/ NewYork, 18th September 2019. Surgery
for stress urinary incontinence
(leaking that occurs with a cough or
sneeze) improves symptoms of another form of incontinence, called urgency
urinary incontinence,
in women who have both types, according to a
study supported by the National Institutes of Health. The findings challenge
current treatment guidelines, which suggest that the surgery may worsen urgency
urinary incontinence in women with both forms, also called mixed urinary
incontinence. The study appears in the Journal of the American Medical
Association
. Funding was provided by NIH’s Eunice Kennedy Shriver
National Institute of Child Health and Human Development (NICHD) and Office of
Research on Women’s Health.

“Women with mixed urinary incontinence may have more
bothersome symptoms than women with either stress or urgency urinary
incontinence alone,” said Donna Mazloomdoost, M.D., study author and program
director of the NICHD Pelvic Floor Disorders Network. “The findings show
promise in treating a condition that can be hard to manage under existing
practices.”

Roughly one-third to one-half of all women with urinary incontinence
have mixed urinary incontinence. Urgency urinary incontinence results from the
spontaneous contraction of bladder muscles, leading to a strong and sudden need
to urinate. Stress urinary incontinence occurs when urine leaks out after
abdominal pressure increases following a sneeze, cough, laugh or movement,
which squeezes the bladder.

Standard treatment guidelines for mixed urinary
incontinence
often involve treating the two forms of incontinence
independently. Urgency urinary incontinence often is first treated with
behavioral techniques, such as trying to delay urinating for a brief period
after feeling the urge, reducing liquid consumption, exercises to strengthen
muscles around the bladder (involving pelvic floor physical therapy) and with medication.
Surgery is not usually recommended early on. Stress incontinence also can be
treated with exercises, and many women experience symptom improvement. However,
in women who do not improve or opt out of the exercises, surgery may be
offered.

The Effects of Surgical Treatment Enhanced with Exercise for
Mixed Urinary Incontinence (ESTEEM) study is a randomized clinical trial that
recruited 480 women with mixed urinary incontinence at centers across the
United States. All participants underwent mid-urethral sling surgery, a
well-established method that places a thin strip of mesh under the urethra;
this helps prevent urine from leaking out during an exertion, such as a sneeze
or cough. Participants were randomized to surgery alone or surgery with behavioral
and pelvic floor muscle therapy, which included six visits with a trained
health professional. They were followed for one year.

The women responded to a questionnaire, the urogenital
distress inventory (UDI), which inquired about urinary symptoms. Symptoms are
ranked from 0-300 points, depending on severity. They also responded to surveys
on quality of life and perceptions of surgical success.

The study team found that both groups had significant
improvements in their incontinence symptoms after surgery. The average UDI
score for the surgery alone group was 176.8 before surgery and 40.3 a year
after surgery; for the surgery and therapy combined group, the UDI score
dropped from 178.0 to 33.8. According to the researchers, because the post-treatment
UDI scores between the two groups did not differ greatly, adding behavioral and
pelvic floor muscle therapy to the treatment may not result in better clinical
outcomes.

However, the study team did find differences in other
self-reported outcomes. The combined surgery and physical therapy group had
fewer instances of incontinence a year after surgery and were less likely to
receive additional treatment for urinary tract symptoms, suggesting they had
more quality of life improvement than the surgery alone group.

“Current practice guidelines may be unnecessarily delaying
surgery for women with mixed urinary incontinence,” said Vivian W. Sung, M.D.,
M.P.H., the study’s lead author and a professor at the Warren Alpert Medical
School of Brown University in Providence, Rhode Island. “We hope these findings
will improve how patients are counseled and treated.”

The researchers called for additional research to identify
which patients with mixed urinary incontinence are at risk for continued
symptoms after surgery and to identify effective treatments for them.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all.

Be the first to comment on "Surgery may benefit women with two types of urinary incontinence"

This site uses Akismet to reduce spam. Learn how your comment data is processed.

shares