Antecedent history as a predictor of surgical cure of urgency symptoms in mixed incontinence

To determine the cure rate of urge incontinence after Burch colposuspension in patients with mixed incontinence diagnosed urodynamically, to determine if cure rates were different when the onset of urge symptoms antedated or postdated the symptoms of stress incontinence, and to propose appropriate preoperative counseling of patients based on this information.

Forty-six women with urodynamically diagnosed genuine stress incontinence and detrusor instability underwent Burch colposuspension. History of chronologic onset of stress incontinence or urge incontinence was recorded. Detailed history, clinical examination, and multichannel urodynamic and other functional studies were carried out on each patient preoperatively and postoperatively. Postoperative urodynamic studies were performed only in patients with persistent symptoms. Patients were assigned to the antecedent stress or antecedent urge group depending on which symptom(s) occurred first. Cure rates in each group were calculated and compared with history of incontinence.

Fifty-eight of 82 patients with complaints of both stress and urge incontinence were diagnosed urodynamically as having mixed incontinence; 46 of them met the study criteria and underwent Burch colposuspension. Stress incontinence preceded urgency in 28 of the 46 patients (61%); urgency occurred first in the remaining 18 (39%). The cure rate of 78.6% (22 of 28) for urge incontinence was statistically significantly greater in the antecedent stress group compared with 22.2% (four of 18) in the antecedent urge group (P < .001).

Patients with a primary presenting symptom of stress incontinence who later develop urge incontinence are 2.5 times more likely to be cured of urge incontinence by Burch colposuspension than patients whose primary presenting symptom is urge incontinence.