Abstract

Tamer F Borg*, Hazem M Sammour**, Mohamed M Shahin***

This double armed clinical trial aimed to compare the outcome of medical versus surgical management of patients with urodynamically-proven mixed incontinence and to identify risk factors for success of each. 138 patients with mixed urinary incontinence (MUI) were studied. 78 patients with urge predominant were allocated medical treatment, 60 patients were classified as stress predominant and allocated surgical treatment. The primary outcome (Patient Global Impression Index of Improvement (PGI-I)) was analyzed in 129 (93.4%) patients. 63.3% of patients in the surgical group showed improvement of their stress component with 43.3% showing improvement in both stress and urgency components. 51.2% of patients in the medical group showed improvement in their urgency component with 33.3% showing improvement in both stress and urgency components. Maximal detrusor pressure and maximal urethral closure pressure were the only independent predictors of failure of medical treatment while the Valsalva leak point pressure was the only independent predictor of failure of surgical treatment. A prediction regression model can predict the outcome of the medical or surgical route.