Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians
Xavier Fritel, Arnaud Fauconnier, Georges Bader, Michel Cosson, Philippe Debodinance, Xavier Deffieux, Pierre Denys, Philippe Dompeyre, Daniel Faltin, Brigitte Fatton, François Haab, Jean-François Hermieux, Jacques Kerdraon, Pierre Mares, Georges Mellier, Nathalie Michel-Laaengh, Cédric Nadeau, Gilberte Robain, Renaud de Tayrac, Bernard Jacquetin, French College of Gynaecologists and Obstetricians, Xavier Fritel, Arnaud Fauconnier, Georges Bader, Michel Cosson, Philippe Debodinance, Xavier Deffieux, Pierre Denys, Philippe Dompeyre, Daniel Faltin, Brigitte Fatton, François Haab, Jean-François Hermieux, Jacques Kerdraon, Pierre Mares, Georges Mellier, Nathalie Michel-Laaengh, Cédric Nadeau, Gilberte Robain, Renaud de Tayrac, Bernard Jacquetin, French College of Gynaecologists and Obstetricians
Abstract
Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.
Copyright (c) 2010. Published by Elsevier Ireland Ltd.
Source: PubMed