Options
- Treat the most bothersome symptom for the patient
- Treat urgency / OAB first
- Treat SUI first
Principles:
- Use conservative measures for both types concurrently (lots of overlap – weight loss, oestrogen, physio)
- UDS probably going to be helpful
- Look for prolapse, oestrogen etc as well and exclude other contributors (UTI, cancer etc.)
Treating UUI / OAB first:
- Medical therapy and botox all largely well tolerated
- Treating OAB is less invasive
- SUI surgery can have significant complications and morbidity
- Success rates for invasive SUI surgery lower when MUI present
- UUI may be more distressing for patients due to lack of predictability cf. SUI
Treating SUI first:
- Slings and colposuspension have been shown to improve or even cure UUI in some women
- High patient satisfaction for MUI patients with slings (although noted success rates lower)
- May potentially treat all with one procedure and avoid medications and associated risks
- The evidence that OAB worsens after SUI surgery is sketchy, and it probably just persists
Treat the most bothersome symptom first:
- Supported by EAU guidelines
- May be difficult to pin patient down on which is more bothersome
- Beware cough induced overactivity