An effective day case treatment combination for refractory neuropathic mixed incontinence

objective: women with drug refractory neurogenic mixed incontinence (nmi) have limited minimally invasive treatment options and require reconstructive surgery. we examined efficacy of a combination of day case intradetrusor (id) botulinum toxin (btx-a) bladder injections and transobturator (tot) or tension free vaginal tape (tvt). materials and methods: eleven women who are pharmacotherapy intolerant or who have drug refractory nmi were treated. two opted for open surgery and the remaining 9 received 1000 units of dysport diluted in 30 ml saline cystoscopically at 30 id sites followed by tot in 6 or tvt in 3 as a day case combination treatment. patient demographics, pre and post treatment videocystometrogram (vcmg), pad test and international committee on incontinence questionnaire (iciq) scores were recorded. at 6 weeks (repeat iciq, pad test and patient satisfaction), at 3 and 12 months (vcmg) and 'current' (iciq and patient satisfaction) was recorded. results: the mean age was 56.7 years (range 41 to 78) with a mean follow up of 19.1 months (range 7 to 33). all women were continent at 3 and 12 months. quality of life (iciq scores) improved at 6 weeks (p > 0.001) and remained stable up to the last follow up (p > 0.001). eight women have stopped using pads. at 3 months, there was significant improvement in mdp (p > 0.014) and mcc (p = 0.002). anticholinergics were discontinued in 7 with global high satisfaction with the treatment btx-a injections were repeated in 4 (mean 13.5 months). conclusion: anticholinergic refractory women with nmi can be effectively treated as a day case with combination of id btx-a injections and tvt or tot.