Stress Urinary Incontinence Management in the Patient With Overactive Bladder

Purpose of the Review

Mixed urinary incontinence is a common diagnosis that has significant impact on patient quality of life and can be more bothersome to patients compared to pure stress incontinence. Given the complexity of concomitant stress incontinence and overactive bladder symptoms, mixed urinary incontinence can often present as a clinically challenging scenario for treating physicians across different subspecialties and primary care medicine. In this review, we discuss the importance of a judicious evaluation and the utility of deciphering stress-predominant versus urge-predominant urinary incontinence in patients with concomitant symptoms.

Recent Findings

The temporal relationship between stress incontinence and urgency symptoms has been explored in recent literature. Although a common pathway has been alluded, characterization of the predominant symptom is essential in treating this difficult diagnosis. As suggested in recent guidelines, emphasis should be placed on setting appropriate patient goals of care and discussing treatment expectations in order to best optimize patient satisfaction and patient-reported treatment success. Risks, benefits, and alternatives for both stress urinary incontinence and overactive bladder treatment options should be reviewed, yet there is lack of a standardized approach in the literature.

Summary

We outline a sequential algorithm to help guide patient counseling, management, and appropriate expectations for treatment of mixed urinary incontinence.