Effective Use of Surgery in Managing Mixed Incontinence

Surgery is a common intervention for stress incontinence and is also clearly an effective option for some patients with mixed incontinence, although success rates are lower in the latter indication. This may be partly due to a lack of clarity regarding terminology, which causes difficulties in predicting suitable patients and comparing clinical trial data. The presence of low-pressure detrusor overactivity may encourage a surgical approach. Women with mixed incontinence with a clearly positive stress test and urethral hypermobility will almost certainly have the stress incontinence element of the condition cured by surgery, but they may require ongoing antimuscarinic agents for urgency and related symptoms. It is important not to create unreasonable patient expectations and women with stress-predominant incontinence need to be aware of the small risk of emerging from surgery with new urgencyrelated symptoms. Advances in surgical techniques (e.g., use of tensionfree vaginal tape) means more research is needed to establish which patients with mixed incontinence are most likely to benefit from surgical intervention. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.