Sling vs Botox for Mixed Incontinence

Inclusion Criteria

• Reporting at least "moderate bother" from UUI item on UDI
• "Do you experience urine leakage associated with a feeling of urgency?"
• Reporting at least "moderate bother" from SUI item on UDI
• "Do you experience urine leakage related to physical activity, coughing, or sneezing?"
• Diagnosis of SUI defined by a positive cough stress test (CST) or UDE within the past 18 months
• Presence of UUI on bladder diary with > 4 Urgency IE/3-day diary
• Urinary symptoms >3 months
• Persistent symptoms despite at least one or more conservative treatments (e.g. supervised behavioral therapy, physical therapy) as determined adequate by the physician.
• Inadequate response to oral overactive bladder medications (including anti-cholinergic and/or beta-mimetic medication) unless patient is
• intolerant of oral overactive bladder medications, or
• oral overactive bladder medications are contraindicated as determined by the treating provider.
• Urodynamics within past 18 months
• Demonstrates ability (or have caregiver demonstrate ability) to perform clean intermittent self-catheterization.

Exclusion Criteria

• Anterior or apical compartment prolapse at or beyond the hymen (>0 on POPQ), regardless if patient is symptomatic
• Women with anterior or apical prolapse above the hymen ( 0
• Women undergoing only rectocele repair or other repair unrelated to anterior or apical compartment are eligible
• Women undergoing hysterectomy for any indication will be excluded
• Active pelvic organ malignancy
• Age 150 cc on 2 occasions within the past 6 months, or current catheter use
• Participation in other trial that may influence results of this study
• Unevaluated hematuria
• Prior sling, synthetic mesh for prolapse, implanted nerve stimulator for urinary incontinence
• Spinal cord injury or advanced/severe neurologic conditions including Multiple Sclerosis, Parkinsons, Myasthenia Gravis, Charcot-Marie-Tooth
• Women on overactive bladder medication/therapy will be eligible after 3 week wash-out period
• Non-ambulatory
• History of serious adverse reaction to synthetic mesh
• Not able to complete study assessments per clinician judgment, or not available for 6 month follow-up
• Diagnosis of and/or history of bladder pain or chronic pelvic pain
• Women who had intravesical Botox injection within the past 12 months
• Women who have undergone anterior or apical pelvic organ prolapse repair within the past 6 months