Combination therapy with botulinum toxin and bulking agent-An efficient, sustainable, and safe method to treat elderly women with mixed urinary incontinence.
AIMS
To evaluate the efficacy, sustainability and safety of combined botulinum toxin and polyacrylamide hydrogel (PAHG) therapy to treat urgency and stress components of therapy-refractory mixed urinary incontinence (MUI) in an elderly study population.


METHODS
Fifty-five women with therapy-refractory MUI were treated with botulinum toxin and PAHG in one surgical procedure. Urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) outcomes were separately assessed after 4 and 12 months by objective UUI episodes/24 h and cough test, subjective impact of UUI and SUI on quality of life, and subjective International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). MUI outcome was calculated by combining UUI and SUI outcomes. Complications were monitored throughout the study.


RESULTS
At 4 months, objective cure rates were 73%, 53%, and 42%, and subjective cure rates were 71%, 52%, and 50% for SUI, UUI, and MUI. At 12 months, objective cure rates were 73%, 56%, 50% and subjective cure rates were 78%, 42%, and 40% for SUI, UUI, and MUI. The ICIQ-UI SF score decreased by 9.0 and 8.7 points after 4 and 12 months. All complications were transient and included 22% clean intermittent catheterization immediately after surgery, 33% postvoid residual volumes >100 ml at 14 days, and 13% symptomatic urinary tract infection within the first postoperative month.


CONCLUSIONS
The combination of botulinum toxin and PAHG is effective, sustainable and safe to treat therapy-refractory MUI, even in an elderly and frail study population. Patients benefit from the short surgical procedure without the need for general anaesthesia or discontinuation of anticoagulation.
['Viereck|Volker|V|0000-0002-1116-8912', 'Gamper|Marianne|M|0000-0002-8235-1239', 'Walser|Claudia|C|', 'Fesslmeier|Debra|D|', 'Münst|Julia|J|', 'Zivanovic|Irena|I|']
D000368:Aged D001905:Botulinum Toxins D005260:Female D006801:Humans D011788:Quality of Life D016896:Treatment Outcome D014549:Urinary Incontinence D014550:Urinary Incontinence, Stress D053202:Urinary Incontinence, Urge
polyacrylamide hydrogel urgency urinary incontinence stress urinary incontinence 1-year follow-up Botox Bulkamid therapy-refractory urinary incontinence