**A Comparative Observational Study to Evaluate the E**ffi**cacy of Mid-Urethral Sling with Botulinum Toxin A Injection in Urinary Incontinence Patients**

**Yi-Huei Chang 1,2,**†**, Po-Jen Hsiao 1,2,3,**†**, Huang Chi-Ping 1,2, Hsi-Chin Wu 1,2,4, Po-Fan Hsieh 1,2,5,\* and Eric Chieh-Lung Chou 1,2,4,\***


Received: 17 April 2020; Accepted: 28 May 2020; Published: 2 June 2020

**Abstract:** This study aimed to evaluate and compare the efficacy and safety of mid-urethral sling (MUS) with botulinum toxin A (BoNT-A) versus MUS only in women with mixed urinary incontinence. This was a comparative observational study, and total of 73 patients were enrolled. A total of 38 and 35 patients received MUS only and MUS with BoNT-A injection, respectively. The efficacy outcome included change in Urinary Incontinence Outcome Scores (UIOS), change in Overactive Bladder Symptom Score (OABSS), and use of antimuscarinic agent or beta-3 agonist. Safety assessments included adverse events including urinary retention, increased postvoid residual volumes, and urinary tract infection. MUS with BoNT-A injection was insignificantly better than MUS only in urinary incontinence outcome (88% vs. 71%, respectively, *p* = 0.085) at week three. Among the 33 patients with detrusor overactivity (DO), patients who received BoNT-A had a higher cure rate of incontinence (88% vs. 41%, *p* = 0.01) and less required antimuscarinic agent or beta-3 agonist (31% vs. 94%, *p* < 0.001) compared to patients who did not receive BoNT-A injection. There was no significant difference in the incidences of adverse events between two groups. BoNT-A injection with MUS demonstrated efficacy and safety in the treatment of mixed urinary incontinence, specifically for women with DO.

**Keywords:** botulinum toxin A; mid-urethral sling; antimuscarinics; overactive bladder; urinary incontinence

**Key Contribution:** This study confirmed the efficacy and safety of BoNT-A injection along with MUS in women with mixed urinary incontinence.
