Guideline of guidelines: urinary incontinence in women

Abstract

Keywords urinary incontinence, overactive bladder, diagnosis, stress urinary incontinence, urgency urinary ncontinence Key Points• Guidelines are not exhaustive, but practical evidencebased reviews of 'index patients'.• Evaluation should include detailed history and characterisation of urinary incontinence (UI).• Guidelines suggest a stepwise approach to treat both urgency UI and stress UI, starting with conservative therapy, advancing to more invasive procedures as needed • Urodynamics should be used when it will change management and if there is recurrent UI after failure of invasive treatments.• When treating women with mixed UI, focus on treating the predominant symptom.

Relationship between the types of urinary incontinence, handgrip strength, and pelvic floor muscle strength in adult women

“…Urodynamic studies may be performed if these tools are inconclusive to determine the type of urinary incontinence affecting the patient. A surgical management plan is introduced in cases where there is a discordance between patient history and physical examination and no improvement is observed in the UI despite the nonsurgical treatment 6,7 . Presence of involuntary detrusor contractions during urodynamic assessment, either spontaneously or with stimulation, is called DO and a diagnosis of DO incontinence (DOI) is supported if urinary incontinence occurs during these involuntary contractions.…”

Long‐term outcomes of artificial urinary sphincter in female patients with spina bifida

“…The impaired neural supply jeopardizes the urinary sphincter function causing a lack of urethral resistance. Artificial urinary sphincter (AUS) implantation is one of the surgical options in female SUI mostly used in women with intrinsic sphincter deficiency (ISD) 6,8,9 . Female AUS has been reported to provide robust functional outcomes and might be regarded as well suited to address the often severe ISD‐related SUI of female patients with spina bifida 4,5 .…”

Guidelines on urinary incontinence: it is time to join forces!

“…In this month’s issue of the BJUI , Sussman et al [1] present a Guideline of Guidelines on urinary incontinence in women. They reviewed the guidelines of the American College of Obstetrics and Gynecology (ACOG) / American Urogynecologic Society (AUGS), American Urological Association (AUA) / Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), European Association of Urology (EAU), International Consultation on Incontinence (ICI), and National Institute for Health and Care Excellence (NICE).…”

“…Although the management of urinary incontinence is well defined and excellently summarised by Sussman et al [1], treatment often remains demanding in daily clinical practice due to insufficient effectiveness or relevant side effects, so that new therapeutic options are urgently needed. Vibegron is a novel β3‐adrenoreceptor agonist, and Yoshida et al [2] present in the current issue of the BJUI promising findings with this drug for treating severe urgency urinary incontinence related to overactive bladder.…”

“…This is a major challenge, and from a bird’s eye view, it is hard to comprehend that several guidelines on the same topic exist and it is even more difficult to understand that the recommendations of these guidelines are not congruent and sometimes even contradictory. For instance, in the case of a pelvic organ prolapse repair in a continent woman, the ACOG / AUGS, AUA / SUFU, and EAU guidelines discuss prophylactic anti‐incontinence surgery as an option, whereas ICI and NICE guidelines explicitly recommend against it [1]. The redundancy is enormous, but societies and organisations still create their own guidelines – an unnecessary waste of resources.…”