International Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


July 10, 2018

In This Article

Urinary Incontinence

European Association of Urology

Ask patients with urinary incontinence to complete a voiding diary when standardized assessment is needed.

Use a diary duration of at least 3 days.

Perform urinalysis as a part of the initial assessment of a patient with UI.

Do not routinely treat asymptomatic bacteriuria in elderly patients to improve UI.

When measuring PVR (postvoid residual urine volume), use ultrasound.

Measure PVR in patients with UI who have voiding symptoms, especially those being considered for surgical treatment. Measure PVR when assessing patients with complicated UI.

Do not routinely carry out urodynamics when offering treatment for uncomplicated stress urinary incontinence (SUI). Perform urodynamics if the findings may change the choice of invasive treatment.

Use a pad test of standardized duration and activity protocol.

Take a history of current medication use from all patients with UI.

Offer incontinence pads and/or containment devices for management of UI.

Advise adults with UI that reducing caffeine intake may improve symptoms of urgency and frequency but not incontinence. Review type and amount of fluid intake in patients with UI.

Offer bladder training as a first-line therapy for adults with UUI (urge urinary incontinence) or mixed urinary incontinence (MUI). Offer supervised pelvic floor muscle training (PFMT), lasting at least 3 mo, as a first-line therapy for all women with SUI or MUI (including the elderly and postnatal). Offer instruction on PFMT to men undergoing radical prostatectomy to speed recovery from UI.

Consider percutaneous tibial nerve stimulation (PTNS) as an option for improvement of UUI in women who have not benefited from antimuscarinic medication.

Offer antimuscarinic drugs or mirabegron for adults with UUI who failed conservative treatment. Consider extended-release formulations of antimuscarinic drugs whenever possible. If an antimuscarinic treatment proves ineffective, consider dose escalation or offering an alternative antimuscarinic formulation or mirabegron or a combination.

Long-term antimuscarinic treatment should be used with caution in elderly patients, especially those who are at risk of, or have, cognitive dysfunction.

Offer duloxetine in selected patients with symptoms of SUI (stress UI) when surgery is not indicated. Duloxetine should be initiated and withdrawn using dose titration because of high risk of adverse event.

Offer long-term vaginal estrogen therapy to postmenopausal women with UI and symptoms of vulvo-vaginal atrophy.



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