Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)

Abstract

The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100 mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100 mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.

A case of tape infection 19 years after insertion of a tension‐free vaginal tape sling

“…Tension-free vaginal tape (TVT) surgery for stress urinary incontinence is strongly recommended by guidelines, but rarely results in severe complications. 1 In past reports, TVT has been associated with more bladder perforation than transobturator tape, 2 which is attributed to the route of tape insertion. Watanabe et al reported a rare case of tape infection 19 years after insertion of a TVT.…”

“…The treatment of SUI includes physical therapy, medication, and surgery 1 . Insertion of TVT, one of the minimally invasive techniques used for women with SUI, is widely performed because of its efficacy, but its complications cannot be ignored.…”

“…The treatment of SUI includes physical therapy, medication, and surgery. 1 Insertion of TVT, one of the minimally invasive techniques used for women with SUI, is widely performed because of its efficacy, but its complications cannot be ignored. The main complications of TVT surgery are bladder stones, bladder perforation (3.5%), tape erosion (0.2%), urinary tract infections (0.7–17%), pelvic hematomas (3.4%), and in rare cases, intestinal, and vascular injury.…”

Sarcopenia and Visceral Obesity are Significantly Related to Severe Storage Symptoms in Geriatric Female Patients

“…Furthermore, storage symptoms significantly affected quality of life. 13 A previous report suggested that the incidence of OAB symptoms in women increases with an increase in their age. 14 Thus, it was clinically important to elucidate the factors responsible for the development of LUTS, especially the storage symptoms.…”

Editorial Comment to A case of tape infection 19 years after insertion of a tension‐free vaginal tape sling

“…Tension‐free vaginal tape (TVT) surgery for stress urinary incontinence is strongly recommended by guidelines, but rarely results in severe complications. 1 In past reports, TVT has been associated with more bladder perforation than trans‐obturator tape, 2 which is attributed to the route of tape insertion. Watanabe et al.…”