SUI and UUI show complex interrelationship

Jan 6 2014

By Joanna Lyford, Senior medwireNews Reporter

A study by US researchers has failed to identify any modifiable risk factors for urgency urinary incontinence (UUI) among women undergoing surgery for stress urinary incontinence (SUI).

The team analyzed data on 1252 women who had participated in one of two randomized clinical trials of surgery for SUI, the SISTEr (fascial sling versus Burch colposuspension) and TOMUS (retropubic versus transobturator midurethral sling) trials.

All women had predominant SUI but a large proportion (68–70%) also had bothersome UUI, ie, mixed urinary incontinence (MUI), at baseline, report Leslie Rickey (Yale University, New Haven, Connecticut, USA) and co-authors in Advances in Urology.

Compared with women with SUI alone, women with MUI were significantly more likely to be postmenopausal, to have previously received treatment for incontinence, to have undergone hysterectomy, and to have a lower level of educational attainment.

Women with MUI also had higher scores on the irritation domain of the Urogenital Distress Inventory and the Patient Health Questionnaire-9, which assesses depression.

In multivariate analysis, the sole factor independently associated with UUI was quality of life.

Using a broader definition encompassing the bother and severity of lower urinary tract symptoms (LUTS), including UUI, significant independent predictors of greater severity included lower educational attainment, increasing pad weight, more severe depression, increasing age, and more comorbidities.

The researchers note that women with MUI tended to report a lower quality of life than those with SUI alone; furthermore, the severity of SUI symptoms predicted the severity of UUI symptoms and more bother from overall irritative lower urinary tract symptoms.

“Although we did not find any baseline patient variables that were associated with UUI in patients undergoing SUI surgery, interesting questions regarding the effect of systemic medical conditions on overactive bladder symptoms were raised and may represent targets for intervention,” they write.

They say: “Clearly, further investigation using a well-characterized population and validated pelvic floor instruments is necessary to clarify the role of depression and concomitant medical conditions in the pathophysiology of UUI and LUTS in women.”

The team adds that greater emphasis on “phenotyping” of these patient populations may shed light on the complex relationship between UUI and SUI and allow clinicians to more accurately predict surgical outcomes.

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