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Clinical Crossroads |

Female Mixed Urinary Incontinence A Clinical Review

Deborah L. Myers, MD1
[+] Author Affiliations
1Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
JAMA. 2014;311(19):2007-2014. doi:10.1001/jama.2014.4299.
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Importance  Mixed urinary incontinence, a condition of both stress and urge urinary incontinence, is prevalent in 20% to 36% of women and is challenging to diagnosis and treat because urinary symptoms are variable and guidelines for treatment are not clear.

Objective  To review the diagnosis and management of mixed urinary incontinence in women, with a focus on current available evidence.

Evidence Review  MEDLINE was searched from January 1, 1992, to December 31, 2013. Additional citations were obtained from references of the selected articles and reviews. Articles that discussed the prevalence, diagnosis, results, and treatment of mixed urinary incontinence were selected for review. Evidence was graded using Oxford Centre for Evidence-Based Medicine levels of evidence for treatment recommendations.

Findings  The MEDLINE search resulted in 785 articles. After selection and obtainment of additional citations, a total of 73 articles were reviewed. There is high-quality (level 1) evidence for treating urinary incontinence with weight loss, for treating stress urinary incontinence by performing anti-incontinence procedures of both traditional and mid-urethral slings and retropubic urethropexies, and for managing urge urinary incontinence with anticholinergic medications. However, direct high-quality evidence for treatment of women with mixed urinary incontinence is lacking, as are clear diagnostic criteria and management guidelines.

Conclusion and Relevance  High-quality, level 1 evidence for urinary incontinence therapy can guide clinicians in the treatment of the components of mixed urinary incontinence. Because high-quality evidence is lacking regarding the treatment of mixed urinary incontinence, treatment generally begins with conservative management emphasizing the most bothersome component. Randomized trials in women with mixed urinary incontinence populations are needed.

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Figure 1.
The 3 Incontinence Questions (3IQ) Questionnaire

Adapted with permission from the American College of Physicians.32

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Figure 2.
The Questionnaire for Female Urinary Incontinence Diagnosis (QUID)

Adapted with permission from Elsevier Inc.33

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Figure 3.
Basic Anatomy of the Female Pelvic Floor and Lower Urinary Tract
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