--- title: "Urinary incontinence subtype transition disease progression? | Sutter Health" description: "Mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression." url: "https://www.sutterhealth.org/research/publications/urinary-incontinence-subtype-transition-disease-progression-1055312746" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Urinary incontinence subtype transition disease progression? # Does transition of urinary incontinence from one subtype to another represent progression of the disease? Minassian VA, Yan X, Pilzek AL, Platte R, & Stewart WF. _Int Urogynecol J. 29(8):1179-1185. doi: 10.1007/s00192-018-3596-4. Epub 2018 Mar 13._ 2018-08-01 ## Abstract INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI. METHODS: We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction. RESULTS: Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI. CONCLUSION: The substantially higher transition from stress UI and urgency UI to mixed UI supports the hypothesis that mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression. ![Xiaowei (Sherry) Yan, Ph.D.](https://dyn.mktgcdn.com/p/NTWox_hkmxIRiqJEc5PXKeBkfR_WMtpSQbEI4J69Xls/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Xiaowei (Sherry) Yan, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042) ## Research topics - [Urologic Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Urologic+Diseases%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Mixed incontinence masked as stress induced urgency urinary incontinence.](https://www.sutterhealth.org/research/publications/mixed-incontinence-masked-as-stress-induced-urgency-ui-1055312723) Minassian VA, Yan XS, Pitcavage J, Stewart WF. J Urol. 196(4):1190-5. doi: 10.1016/j.juro.2016.04.084. Epub 2016 May 6. 2016 Oct 01 - Publication ### [The interaction of stress and urgency urinary incontinence and its effect on quality of life.](https://www.sutterhealth.org/research/publications/stress-vs-urgency-ui-and-effect-on-qol-1055312598) Minassian VA, Sun H, Yan XS, Clarke DN, Stewart WF. Int Urogynecol J. 26(2):269-76. doi: 10.1007/s00192-014-2505-8. Epub 2014 Oct 3. 2015 Feb 01 - Publication ### [The iceberg of health care utilization in women with urinary incontinence.](https://www.sutterhealth.org/research/publications/health-care-utilization-in-women-with-ui-is-low-1055312611) Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. Int Urogynecol J. 23(8):1087-93. doi: 10.1007/s00192-012-1743-x. Epub 2012 Apr 12. 2012 Aug 01 - Publication ### [Clinical validation of the Bladder Health Survey for urinary incontinence in a population sample of women.](https://www.sutterhealth.org/research/publications/clinical-validation-of-bladder-health-survey-for-ui-1055312569) Minassian VA, Yan XS, Sun H, Platte RO, Stewart WF. Int Urogynecol J. 27(3):453-61. doi: 10.1007/s00192-015-2849-8. Epub 2015 Sep 19. 2016 Mar 01 - Publication ### [Predictors of care seeking in women with urinary incontinence.](https://www.sutterhealth.org/research/publications/predictors-of-care-in-women-with-urinary-incontinence-1055312738) Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. Neurourol Urodyn. 31(4):470-4. doi: 10.1002/nau.22235. Epub 2012 Feb 29. 2012 Apr 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/urinary-incontinence-subtype-transition-disease-progression-1055312746#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Urinary incontinence subtype transition disease progression?"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/urinary-incontinence-subtype-transition-disease-progression-1055312746#medicalscholarlyarticle","name":"Does transition of urinary incontinence from one subtype to another represent progression of the disease?","headline":"Urinary incontinence subtype transition disease progression?","abstract":"INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI. METHODS: We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction. RESULTS: Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI. 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