Diffusion des recommandations pour la pratique clinique concernant l’incontinence urinaire de la femme

Management of urinary incontinence in females by primary care providers: a systematic review

“…Studies were published between 1990 and 2022: nine of the 31 studies were published before or in 2000, 11 between 2001 and 2010, and 11 between 2011 and 2022. Included studies assessed the practice patterns of PCPs in the United States (nine studies), the Netherlands (five), the UK (five), Norway (three), Canada (three), Australia (one), Denmark (one), France (one), Germany (one), and one pan‐European study in France, Germany, Spain and UK (Table 1 [10,27–57]).…”

“…Following guideline recommendations for the initial evaluation of UI by PCPs, studies reported a high adherence for completing a detailed history taking with patients (71–98% adherence range; based on three studies) [31,48,49]. When the studies looked more precisely at individual queries, PCPs characterised UI by asking about leakage associated with intra‐abdominal pressure (39–99%; three studies) [33,45,46], symptoms of urgency (22–97%; three studies) [33,45,46], frequency (44–78%; two studies) [33,45], UI patterns (17–58%; two studies) [33,45], amount of urine loss (44%; one study) [45], pad use (71%; one study) [45] and the impact of UI on quality of life (61%; one study) [45].…”

“…From the recommended assessments highlighted in Box 1, PCPs adherence was variable: pelvic examination (23–76%; eight studies) [27–29,31–33,45,46,57], abdominal examination (0–87%; three studies) [29,33,45], pelvic floor muscle evaluation (9–36%; two studies) [49,57], bladder diary (0–92%; nine studies) [27,28,31,32,40,45,46,48,49,57], and urine analysis (40–97%; nine studies) [27–29,31,32,45,46,48,51,57]; see Table S6 for detailed reporting. PCPs also performed testing deemed unnecessary in guidelines for the initial assessment of UI or for uncomplicated cases of UI, including routine imaging, and urodynamics, which were respectively practiced (0–24%; five studies) [27,28,32,33,49,51] and (26–71%; three studies) [31,37,49]. From the three qualitative studies that looked at assessment of UI by PCPs [35,42,44], all reported that most GPs do not perform adequate physical examination (pelvic and abdominal) or other testing relevant to UI such as a bladder diary, pelvic floor muscle evaluation or cough stress test.…”

“…Figure 3 shows the degree of adherence to guideline recommendations reported for the objective evaluation of UI. In terms of other assessments performed, PCPs used cough test (12–75%; four studies) [27,28,31,32,49], standardised questionnaires to assess quality of life (0–34%; two studies) [48,49], neurological examination (10–15%; two studies) [27,28,32], post‐void residual volume (5–44%; four studies) [27,28,31,32,48], pad tests (2–3%; two studies) [48,49], rectal palpation (0–54%; two studies) [33,45] and blood glucose (73%; one study) [31].…”

Évolution de l’activité chirurgicale liée à l’incontinence urinaire d’effort (IUE) au regard du vieillissement de la population féminine française

“…Cette sous-déclaration de l'IUE par défaut d'information et/ou stigmatisation du problème (honte) pourrait expliquer que l'évolution de l'activité chirurgicale liée à l'IUE ne semble pas suivre l'évolution du vieillissement de la population féminine française [38]. Ce phénomène pourrait être amplifié par une information insuffisante des médecins généralistes [39].…”