**5. Materials and Methods**

This retrospective observational comparative study was done in a tertiary referral center. The inclusion criteria were women who had at least one episode of SUI and one episode of UUI in a 3-day voiding diary. Patients with urethral diverticulum, urinary fistula, previous urinary incontinence surgery, intravesical BoNT-A injection, or pelvic floor reconstruction, and history of neurogenic bladder were excluded. If they had previously taken medications for OAB, a 3-week washout period was required before surgery. This study was approved by the Ethic Committee of China Medical University Hospital, and the protocol number was DMR-94IRB-083(FR) (Approval date: 30 November 2016).

Preoperative evaluation including history assessment, physical examination, urinalysis, urodynamic study, and assessment of OABSS and UIOS were done at the outpatient clinic. The decision of MUS only or MUS with BoNT-A intravesical injection was made by the patient after a detailed explanation of the procedure and morbidities. All patients were reassessed at 1 week, 3 weeks, 3 months, and 6 months after surgery. According to the UIOS, cure, improvement, and failure scored 0, 1–4, and 5, respectively. In our study, a score ranging from 1–5 was defined as the absence of cure [8].

The patients in the MUS only group underwent a surgical procedure performed by a single surgeon (ECL Chou) using a transobturator MUS (Contasure-KIM®, Neomedic International, Leganés, Madrid, Spain). The patients in the MUS with BoNT-A group received transobturator MUS and 80-unit BoNT-A(BOTOX®, Allergan, Irvine, CA, USA) intravesical injection.

During a 3-week evaluation after surgery, patients in both groups were asked if they wanted to receive medication treatment for OAB to control the symptoms of urgency, frequent urination, and urgency incontinence. Six months after the operation, patients who had received BoNT-A intravesical injections were also evaluated if they wanted to repeatedly receive BoNT-A intravesical injection.

All comparisons of patients' categorical characteristics and outcomes were assessed using the Fisher's exact test. Mann-Whitney U test was used to compare the means of continuous variables such as OABSS in two groups. We compare continuous data before and after intervention by Wilcoxon signed rank test. The predictive factor of successful treatment was evaluated by mixed linear regression. All statistical assessments were performed by two-sided analysis, and significant differences were considered at a *p*-value < 0.05. The Statistical Package for the Social Sciences (SPSS) version 19.0 statistical software (SPSS Inc., Chicago, IL, USA) was used in all statistical analyses.

**Author Contributions:** Y.-H.C. and P.-J.H. drafted the manuscript. H.C.-P., H.-C.W., and P.-F.H. revised the manuscript. E.C.-L.C. supervised the drafting and revision of the manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
