Although a large proportion of women complain of both stress and urge incontinence, only about 5% suffer from mixed detrusor overactivity and urethral sphincter incompetence. They pose a difficult management problem. A study comparing medical and surgical treatment has shown that of the 27 women who underwent a Burch colposuspension, 59% were cured and 22% improved; whereas of the 25 who received drug therapy (oxybu-tynin, imipramine and oestrogen) 32% were cured and 28% improved. The authors concluded that combined stress incontinence and detrusor overactivity should be managed medically initially as this will reduce the need for surgical intervention . In such cases, it is our practice to treat the detrusor overactivity with antimuscarinic agents and to repeat the urodynamic assessment while the patient is taking her medication. If she still leaks without significant detrusor activity and her main complaint is stress incontinence, we would undertake conventional bladder neck surgery. However, if urge incontinence still predominates, surgery may aggravate her symptoms.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.