Should conservative management be considered in women with mixed urinary incontinence prior to surgery?


Authors’ Reply


We thank Drs Maggiore, Soligo and Ferrero for their interest in our analysis.1,2 We sought to identify independent risk factors for women who have persistent urgency/urgency urinary incontinence following mid-urethral sling (MUS) procedures. The methodology for multivariate analysis was described clearly in the paper. All of the women in our analysis complained of stress urinary incontinence (SUI), 754 of which also complained of urinary urgency, and 514 also complained of urgency urinary incontinence (UUI). The entire data set in this analysis involved women with both SUI and urgency or urgency and UUI. Although all of the women in our data set have urgency/UUI (together with SUI), not ALL of them have DO. This is clearly described in Table 2.2 We maintain that the title of our article is precise and clear. We agree with Dr Maggiore and his colleagues regarding the need for preoperative conservative therapy, and indeed routinely offer conservative management to women prior to MUS surgery, including supervised pelvic floor muscle exercises, together with providing instructions for bladder retraining and the principles of good bladder habits. We would also routinely consider antimuscarinics for women who also complained of an overactive bladder, as long as there was an absence of contraindications. Over the long period of follow-up in this observational study, it proved difficult to obtain an accurate account of antimuscarinic use, including dosage and different formulations, especially postoperatively. Our experiences were similar to those reported by Gopal,3 who observed a significant discontinuation of antimuscarinic use, to the point of being negligible by year 3, with a median time to discontinuation of 4.76 months. We agree with Dr Maggiore and his colleagues that our analysis provides useful information for patient counselling regarding the persistence of urgency and UUI after MUS, and possible risk factors for this.