ESTEEM Clinical Trial

Up to 50% of the women who seek help for urinary incontinence (or accidental leakage of urine) have a condition called Mixed Urinary Incontinence (MUI). MUI as the name suggests is a combination of two common types of incontinence:

  • Stress Urinary Incontinence (SUI) which is the leakage of urine with activities such as coughing, sneezing, laughing, lifting things, or exercise.
  • Urgency Urinary Incontinence (UUI) which is leakage of urine associated with a sudden need or urge to urinate. Often women leak urine on the way to the bathroom.

Mixed urinary incontinence is a challenging condition to treat because the two causes require two treatment approaches. We know that many women continue to have bothersome urinary symptoms even after pursuing treatment. Women have reported that this type of combination incontinence is more bothersome than having either condition alone. Clinicians and the patients they treat are often frustrated with the treatment of MUI because current treatments only address well one of the types of incontinence.

Are you one of the many American women that experiences frequent urge incontinence or leaks urine twice or more each day?

Currently, treatment strategies focus on addressing the most bothersome symptom. Sometimes this is difficult for women to identify. Current treatments include:

  • Medications:  these are helpful for the urgency component of leakage symptoms. Women often discontinue these medications due to side effects, continued leakage or cost.
  • Behavioral Therapy / Pelvic Floor Therapy:  Working with a physical therapist or specialist in pelvic floor muscle and behavioral therapy has been shown to be helpful for all types of incontinence. This type of therapy provides advice on how much to drink, what bladder irritants to avoid, when to urinate and how to avoid situations that result in leakage. It also includes pelvic floor muscle therapy, designed to strengthen and improve coordination of the pelvic floor muscles to control leakage.
  • Midurethral surgery (‘sling’, TVT, TOT): This outpatient surgery has been shown to be highly successful in the treatment of stress incontinence symptoms. More recent evidence has shown that it may also be helpful in improving the urgency component of mixed urinary incontinence. In this surgery, a small strap of permanent mesh is placed under the urethra (or the tube that drains the bladder when women urinate).

The ESTEEM study has been designed to study whether combining surgery and behavioral/pelvic floor therapy works better for treating MUI compared to having a sling alone. Women in this study have decided with their doctor to proceed with a sling surgery for their urinary incontinence. They will be randomly assigned to receive either the sling surgery alone, or the sling surgery plus behavioral / pelvic floor therapy. Women will attend behavioral / physical therapy visits without cost before and after surgery. All women will be asked about their symptoms for one year after their surgery. The bladder symptoms of women in both groups will be compared one year after surgery.

ESTEEM started enrolling women in the Fall of 2013. The study is expected to be completed in the spring of 2016, so look for results then!

For more information about ESTEEM, please contact Karen Mislanovich RN, the study coordinator, at 412-641-6679 or

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Women's Center for Bladder and Pelvic Health
Magee-Womens Hospital of UPMC
300 Halket Street
Pittsburgh, PA 15213


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