NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

National Collaborating Centre for Women's and Children's Health (UK). Urinary Incontinence: The Management of Urinary Incontinence in Women. London: RCOG Press; 2006 Oct. (NICE Clinical Guidelines, No. 40.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Urinary Incontinence

Urinary Incontinence: The Management of Urinary Incontinence in Women.

Show details

Appendix BGuideline questions

Assessment and investigation

For each ‘test’, or form of investigation or assessment for UI, up to five questions were addressed, as indicated by ticks in the following matrix.

‘Test’Question
Test used to indicate alternative pathway?Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values)Test used to direct treatment or predict outcome? Does it affect outcome?Test used to direct treatment or predict outcome? Does it predict outcome?Test used to measure severity? Test–retest reliability
Urinary history
Bowel history
Medical history
Surgical history
Obstetric history
Drug history
Social circumstances
Expectations and motivation
Cognitive function
Physical examination
Neurophysiology
Pelvic floor muscle assessment
Assessment of prolapse
Urine testing
Assessment of residual urine
Symptom scoring and quality of life
Bladder diary
Pad testing
Urodynamics
Other tests of urethral competence (Q-tip, Fluid-Bridge, Bonney, Marshall)
Cystoscopy
Imaging

indicates the question was addressed;

indicates that the question was not considered to be relevant to the ‘test’ and therefore the question was not addressed.

General

What is the impact of providing information to a woman with UI or OAB in terms of their satisfaction with the outcomes of treatment?

Conservative techniques

Conservative techniques for the treatment of UI

What is the effectiveness of conservative techniques for the treatment of UI or OAB in women?

Where the conservative techniques considered are:

  • lifestyle changes (bowel habit, dietary factors, caffeine, fluid intake, smoking, weight, physical exercise)
  • other behavioural therapies (toileting regimens)
  • physical therapies (pelvic floor muscle training [PFMT], vaginal cones, biofeedback, electrical stimulation, transcutaneous electrical nerve stimulation [TENS], posterior tibial nerve stimulation, magnetic stimulation)
  • drug treatment (antimuscarinic drugs, desmopressin, diuretics, duloxetine, oestrogens)
  • complementary therapies (acupuncture, herbal medicines, hypnosis, aromatherapy, massage, reflexology, osteopathy).

(Effectiveness encompasses benefits, unwanted effects, cost effectiveness, and use of the interventions as monotherapy or in combination with other therapies, at any point in the care pathway.)

Sub-questions for conservative techniques

What is the comparative cost effectiveness of different conservative techniques?

Is one method of PFMT better than another?

Conservative techniques for the prevention of UI

What is the effectiveness of lifestyle changes, behavioural and physical therapies for the prevention of UI or OAB in women?

Non-therapeutic interventions (containment)

In what circumstances should containment be used as the only intervention for women with UI or OAB?

In what circumstances should containment be used prior to more definitive treatment for women with UI or OAB?

Does containment have an impact on quality of life, maintenance of independent living and rates of institutionalism, or return to work in women with UI or OAB?

Surgical procedures

What is the effectiveness of procedures to suspend the vaginal wall for the treatment of UI or OAB in women?

Where the procedures are:

  • suprapubic: open colposuspension, laparoscopic colposuspension (Marshall–Marchetti–Krantz [MMK] or Burch colposuspension, vagino-obturator shelf procedure)
  • bladder neck needle suspension (Pereyra, Stamey, Raz, Gittes)

What is the effectiveness of suburethral retropubic space slings using autologous/biological or synthetic material for the treatment of UI or OAB in women?

Where the suburethral retropubic space slings are:

  • biological: autologous (fascia, dermis, tendon); allograft (fascia, dermis, dura); xenograft (porcine dermis, bovine pericardium, dura, small intestine submucosa)
  • synthetic (e.g. tension-free vaginal tape, suprapubic arc sling).

What is the effectiveness of suburethral obturator foramen procedures using biological or synthetic tapes for the treatment of UI or OAB in women?

Where the suburethral obturator foramen procedures are:

  • biological tapes
  • synthetic tapes (e.g. transobturator tape, transobturator suburethral tape).

What is the effectiveness of implantable devices that have been designed to augment urethral sphincter pressures for the treatment of UI or OAB in women?

Where the devices are:

  • intramural urethral injectables (bulking agents)/devices (e.g. collagen, hydroxyapatite, silicone [ACT Balloon], polytetrafluoroethylene)
  • artificial urinary sphincters (AUS): extraurethral circumferential variable resistance devices (e.g. the AMS artificial urinary sphincter).

What is the effectiveness of augmentation cystoplasty for the treatment of UI or OAB in women?

What is the effectiveness of sacral nerve stimulation for the treatment of UI or OAB in women?

What is the effectiveness of detrusor myectomy for the treatment of OAB in women?

What is the effectiveness of urinary diversion for the treatment of UI or OAB in women?

What is the effectiveness of botulinum toxin for OAB in women?

What is the effectiveness of vanilloid receptor agonists for OAB in women?

What is the effectiveness of removal of concurrent pelvic pathology (hysterectomy) as a treatment for UI in women?

Optimal sequence questions

What is the optimal sequence of interventions and timescales for women with stress UI?

What is the optimal sequence of interventions and timescales for women with mixed UI?

What is the optimal sequence of interventions and timescales for women with overactive bladder (wet or dry)?

Competence

What are the core competencies required by a surgeon performing surgical procedures to treat UI or OAB in women?

Copyright © 2006, National Collaborating Centre for Women’s and Children’s Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK57202

Views

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...