Combination of midurethral sling vs low-dose dysport injection in comparison with midurethral sling alone in mixed incontinence

Abstract

Management of mixed urinary incontinence (MUI) is controversial. There are limited number studies that report on simultaneous treatment approaches. Our primary aim was to determine the outcome of combined trans-obturator tape sling (TOT) and low dose intra detrusor injection of Abobotulinumtoxin-A (Abobot-A, Dysport®) in women with MUI. Methods: This was a prospective clinical trial conducted on 36 women who had the symptoms of MUI and were referred to the urology clinic of Tabriz Imam Reza hospital. All subjects in the study underwent physical examination and history taking. The inclusion criteria were women treated with anticholinergic/ B3 agonists who did not respond or could not tolerate the treatment. Only patient who had detrusor overactivity and positive Valsalva leak point pressure were enrolled in the study. We performed cystoscopy and injected 300 U of Abobotulinumtoxin-A in 30 to 50 intra-detrusor injection sites in 26 patients. This was performed after reconstituting with 5cc distilled water using a 27 Gauge disposable needle in the bladder wall, away from the trigon. All patients underwent the surgical procedure of TOT. We used ICIQ-OAB, ICIQ-SF and PGI-I for outcome measurements in 12 weeks. Results: In urodynamic assessments, patients had VLPP + DO, cough induced DO + leakage and normal/average capacities. The mean age of patients in the combination therapy group was 52.26 and the surgical group was 52.8. The mean scores for the pre-treatment combination treatment group were 17.42 for ICIQ-SF, 9.38 for ICIQ-OAB and 18.2 and 10.9 for the surgery group, respectively. We followed up patients 12 weeks after the intervention. The mean of their ICIQ-OAB symptoms was decreased (P <0.001). The mean ICIQ-SF score also decreased after the intervention (P <0.001). The decrease in mean score based on the questionnaire was significantly higher in the combination therapy group. Due to the improvement using the PGI-I scale, the majority of patients treated with TOT and dysport injection reported that the symptoms of the disease after treatment were "much better" than before the study intervention. Only 10% of people treated with TOT reported this improvement.