title: Outcome after conservative management for mixed urinary incontinence.
abstract: OBJECTIVE
  Recommended initial treatment for mixed urinary incontinence involves behavioral therapy, and drug and pelvic floor muscle exercises. Our objective is to evaluate the outcome of these conservative treatments in our patients with mixed urinary incontinence.
  
  
  METHODS
  A retrospective review was conducted in patients with mixed urinary incontinence who were offered sequential conservative treatment modalities comprised of medication and physiotherapy. Outcome was defined as a score of 1 or less for questions 2 and 3 on the six-item Urodynamic Distress Inventory (UDI-6) and seven-item Incontinence Impact Questionnaire, in addition to clinical symptomatic improvement with no urgency, urge incontinence and voiding frequency of less than eight times per 24 h on a 3-day bladder diary after treatment. Treatment outcome of patients opting for medication plus physiotherapy (M + P) were analyzed against patients preferring medication only (M).
  
  
  RESULTS
  Sixty-two mixed urinary incontinent patients received an initial treatment with conservative measures with mean follow-up of 14 months. A total of 61.2% (30/49) and 56.3% (9/13) subjects had improved symptoms in the M + P and M group, respectively. There was significant improvement in UDI-6 total score in the M + P group after conservative treatment, despite no significant difference when compared to the M group. Only 6.45% required subsequent anti-incontinence surgery after conservative treatment, amongst whom only half showed improvement after the surgery.
  
  
  CONCLUSIONS
  Combined treatment with medication and physiotherapy is highly recommended for patients with mixed urinary incontinence. Conservative measures should still precede any surgical intervention. Further studies are needed to evaluate the long-term efficacy.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China; Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
authors.forename: Sandy Pei-Ying
authors.initials: SP
authors.lastname: Wu
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Leng Boi
authors.initials: LB
authors.lastname: Pue
authors.forename: Eileen Feliz M
authors.initials: EF
authors.lastname: Cortes
authors.forename: Meng-Hsuan
authors.initials: MH
authors.lastname: Lu
authors.forename: Ahlam M
authors.initials: AM
authors.lastname: Al-Kharabsheh
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016587:Antimutagenic Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000503:physiopathology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000628:therapy*
chemical_list: D016587:Antimutagenic Agents
keywords: conservative treatment; mixed urinary incontinence; outcome; seven-item Incontinence Impact Questionnaire; six-item Urodynamic Distress Inventory