Urinary Incontinence

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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F.C. Burkhard (Chair), M.G. ucas, L.C. Berghmans, J.L.H.R. Bosch, F. Cruz, G.E. Lemack, A.K. Nambiar, C.G. Nilsson, A. Tubaro (Guidelines Associates), D. Bedretdinova, F. Farag, B.B. Rozenberg

1.INTRODUCTION

Urinary incontinence (UI) is an extremely common complaint in every part of the world. It causes a great deal of distress and embarrassment, as well as significant costs, to both individuals and societies. Estimates of prevalence vary according to the definition of incontinence and the population studied. However, there is universal agreement about the importance of the problem in terms of human suffering and economic cost.

1.1.Aim and objectives

These Guidelines from the European Association of Urology (EAU) Working Panel on Urinary Incontinence are written by a multidisciplinary group, primarily for urologists, and are likely to be referred to by other professional groups. They aim to provide sensible and practical evidence-based guidance on the clinical problem of UI rather than an exhaustive narrative review. Such a review is already available from the International Consultation on Incontinence [1], and so the EAU Guidelines do not describe the causation, basic science, epidemiology and psychology of UI. The focus of these Guidelines is entirely on assessment and treatment reflecting clinical practice. The Guidelines also do not consider patients with UI caused by neurological disease, or in children, as this is covered by complementary EAU Guidelines [2,3].

The elderly

The Panel decided to include a separate but complimentary set of recommendations referring to the elderly population within each section. Older people with UI deserve special consideration for a number of reasons. Physiological changes with natural ageing mean that all types of UI become more common with increasing age. Urinary incontinence commonly co-exists with other comorbid conditions, reduced mobility, and impaired cognition and may require specific interventions, such as assisted toileting.

For the elderly person expectations of assessment and treatment may need to be modified to fit in with specific circumstances, needs, and preferences, while taking into account any loss of capacity for consent. When the urologist is dealing with a frail elderly patient with urinary incontinence, collaboration with other healthcare professionals such as elderly care physicians is recommended.

It must be emphasised that clinical guidelines present the best evidence available to the experts. However, following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account.

1.2.Panel composition

The EAU Urinary Incontinence Panel consists of a multidisciplinary group of experts, including urologists, a gynaecologist and a physiotherapist. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website: http://www.uroweb.org/guideline/urinary-incontinence.

1.3.Available publications

A quick reference document (Pocket Guidelines) is available, both in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text versions. Two scientific publications in the journal European Urology are also available [4,5]. All documents are accessible through the EAU website: http://www.uroweb.org/guideline/urinary-incontinence.

1.4.Publication history

The EAU published the first Urinary Incontinence Guidelines in 2001 with updates in 2012, 2013, 2014 and 2015. For this 2016 print updates were made to:

  • 4.1 Conservative Management;
  • 4.2.8 Oestrogen;
  • 4.3.6.1 Bladder wall injection of botulinum toxin A.
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