EAU GUIDELINES ON URINARY INCONTINENCE
Authors:
J. W. Thüroff 1; P. Abrams 2; K. E. Andersson 3; W. Artibani 4; C. R. Chapple 5; M. J. Drake 2; C. Hampel 1; A. Neisius 1; A. Schröder 1; A. Tubaro 6
Authors‘ workplace:
Department of Urology, Johannes Gutenberg University, Mainz, Germany
1; Bristol Urological Institute, Southmead Hospital, Bristol, UK
2; Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
3; Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
4; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
5; Department of Urology, University of Rome ‘La Sapienza’ Rome, Italy, joachim. thueroff@unimedizin-mainz. de
6
Published in:
Urol List 2011; 9(4): 71-85
Category:
Guidelines
Overview
Context:
The first European Association of Urology (EAU) Guidelines on incontinence were published in 2001. These guidelines were periodically updated in past years.
Objective:
The aim of this paper is to present a summary of the 2009 update of the EAU Guidelines on urinary incontinence (UI).
Evidence acquisition:
The EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly.
Evidence summary:
A full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depends on severity and/or complexity of symptoms and clinical signs and is different for men, women, frail older persons, children, and patientswith neuropathy. At the level of initialmanagement, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe), more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery.
Conclusions:
Treatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective.
Sources
1. Abrams P, Khoury S, Wein A. Incontinence: 1st International Consultation on Incontinence. Plymouth: Health Publications 1999.
2. Thüroff JW, Abrams P, Artibani W et al. Clinical guidelines for the management of incontinence. In: Abrams P, Khoury S, Wein A (eds). Incontinence: 1st International Consultation on Incontinence. Plymouth: Health Publications 1999: 933–943.
3. Hampel C, Hohenfellner M, Abrams P et al. EAU guidelines on incontinence. Plymouth: Health Publications 2001.
4. Phillips B, Ball C, Sackett D et al. Oxford Centre for Evidence-based Medicine levels of evidence (March 2009). Centre for Evidence Based Medicine Web site. Available from: http://www.cebm.net/index.aspx? o=1025.
5. Abrams P, Khoury S, Grant A. Evidence-based medicine overview of the main steps for developing and grading guideline recommendations. In: Abrams P, Cardozo L, Khoury S et al (eds). Incontinence: 3rd International Consultation on Incontinence. Paris: Health Publications 2005: 10–11.
6. Abrams P, Cardozo L, Wein A et al. Incontinence: 4th International Consultation on Incontinence. Paris: Health Publications 2009.
7. Schröder A, Abrams P, Andersson KE et al. EAU guidelines on urinary incontinence. European Association of Urology Web site. Available from: http:// www.uroweb.org/guidelines/online-guidelines/.
8. Offermans MP, Du Moulin MF, Hamers JP et al. Prevalence of urinary incontinence and associated risk factors in nursing home residents: a systematic review. Neurourol Urodyn 2009; 28(4): 288–294.
9. Botlero R, Davis SR, Urquhart DM et al. Age-specific prevalence of, and factors associated with, different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire. Maturitas 2009; 62(2): 134–139.
10. Wennberg AL, Molander U, Fall M et al. A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women. Eur Urol 2009; 55(4): 783–791.
11. Long RM, Giri SK, Flood HD. Current concepts in female stress urinary incontinence. Surgeon 2008; 6(6): 366–372.
12. Altman D, Forsman M, Falconer C et al. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol 2008; 54(4): 918–922.
13. Rohr G, Kragstrup J, Gaist D et al. Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women. Acta Obstet Gynecol Scand 2004; 83(10): 978–982.
14. Irwin DE, Milsom I, Reilly K et al. Overactive bladder is associated with erectile dysfunction and reduced sexual quality of life in men. J Sex Med 2008; 5(12): 2904–2910.
15. Andersson KE, Appell R, Cardozo L et al. Pharmacological treatment of urinary incontinence. In: Abrams P, Khoury S, Wein A (eds). Incontinence: 3rd International Consultation on Incontinence. Paris: Health Publications 2005: 809–854.
16. Herbison P, Hay-Smith J, Ellis G et al. Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: systematic review. BMJ 2003; 326(7394): 841–844.
17. Chapple C, Khullar V, Gabriel Z et al. The effects of antimuscarinic treatments in overactive bladder: a systematic review and meta-analysis. Eur Urol 2005; 48(1): 5–26.
18. Novara G, Galfano A, Secco S et al. Systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol 2008; 54(4): 740–763.
19. Chapple CR, Khullar V, Gabriel Z et al. The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol 2008; 54(3): 543–562.
20. Andersson KE. Pharmacology of lower urinary tract smooth muscles and penile erectile tissues. Pharmacol Rev 1993; 45(3): 253–308.
21. Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev 2004; 56(4): 581–631.
22. Andersson KE. Current concepts in the treatment of disorders of micturition. Drugs 1988; 35(4): 477–494.
23. Zinner N, Gittelman M, Harris R et al. Trospium Study Group. Trospium chloride improves overactive bladder symptoms: a multicenter phase III trial. J Urol 2004; 171(6 Pt 1): 2311–2315.
24. Cardozo L, Lose G, McClish D et al. A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder. Acta Obstet Gynecol Scand 2004; 83(10): 892–897.
25. Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology 2003; 62 (4 Suppl 1): 45–51.
26. Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: a systematic review and meta-analysis. Neurourol Urodyn 2004; 23(4): 302–305.
27. Rembratt A, Norgaard JP, Andersson KE. Desmopressin in elderly patients with nocturia: short-term safety and effects on urine output, sleep and voiding patterns. BJU Int 2003; 91(7): 642–646.
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