Treatment for Mixed Urinary Incontinence: Mid-urethral Sling vs. Botox A

The MUSA trial was a randomized 2-arm clinical trial conducted to determine whether intradetrusor onabotulinumtoxinA was more effective than midurethral sling for the treatment of mixed urinary incontinence in females. Participants had at least moderately bothersome stress and urge urinary incontinence and had failed one or more conservative treatments. The primary outcome was change at 6 months in mixed incontinence symptoms as measured by the Urogenital Distress Inventory total score. Secondary outcomes included stress and irritative UDI subscores. Among 150 females randomized, 137 were treated and included in the primary analysis. There was no observed difference in UDI total score improvement at 6 months between the onabotulinumtoxinA and midurethral sling groups in females with moderate to severe mixed urinary incontinence who previously did not respond to conservative treatments.