Mixed Incontinence: Medical Or Surgical Approach?

Inclusion Criteria: 1. Female 2. Mixed UI as evidenced by stress and urge symptoms reported on MESA (either percent of urge-type symptoms ≥ the percent of stress-type symptoms or urge symptom score ≥7 if stress predominant) followed by report of "moderately" or "greatly"/"quite a bit" bothered to questions 2 and 3 of the 6-item Urinary Distress Index (UDI-6) or questions 16 and 17 of the 20-item Pelvic Fl;oor Distress Index (PFDI-20), respectively (See Appendix C) 3. Moderate or severe UI as evidenced by the corresponding response on the Patient Global Impression of Severity (PGI-S) 4. Incontinence symptoms present for at least (3) months\* 5. Bladder capacity \> 200cc (by any method) 6. Urodynamic Stress Incontinence 7. Eligible for both treatment interventions 8. Available to start intervention within 6 weeks 9. Negative urine dipstick (negative result = trace or less for leukocytes \& nitrites) 10. Available for 12 months of follow-up and able to complete study assessments as per clinician judgment 11. Signed consent form Exclusion Criteria: 1. Age \<21 years\* 2. Currently undergoing or recommended to undergo treatment of pelvic organ prolapse 3. Other indicated/planned concomitant surgery 4. Pregnant or has not completed child bearing\* 5. \<12 months post-partum\*† 6. Active malignancy of cervix, uterus, fallopian tube(s) or ovary \> Stage I, or bladder of any Stage 7. Current catheter use 8. Unevaluated hematuria 9. Participation in another trial that may influence the results of this study * Patient can be rescreened after respective time interval has been met. †"Partum" is defined as a delivery or other termination that occurs after 20 weeks gestation.