Non-neurogenic Female LUTS

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

ISBN 978-94-92671-13-4

C.K. Harding (Chair), M.C. Lapitan (Vice-chair), S. Arlandis, K. Bø, E. Costantini, J. Groen, A.K. Nambiar, M.I. Omar, V. Phé, C.H. van der Vaart
Guidelines Associates: F. Farag, M. Karavitakis, M. Manso, S. Monagas, A. Nic an Riogh, E. O'Connor, B. Peyronnet, V. Sakalis, N. Sihra, L. Tzelves

1.INTRODUCTION

Lower urinary tract symptoms (LUTS) is the overarching term encompassing storage, voiding and post-micturition symptoms [1]. Storage symptoms commonly described include frequency, urgency, nocturia and urinary incontinence (UI) (stress UI [SUI], urgency UI [UUI] and mixed UI [MUI]). Voiding symptoms include hesitancy, intermittency, slow stream, straining, splitting or spraying of the urinary stream and terminal dribble. Post-micturition symptoms include post-void dribbling and feeling of incomplete bladder emptying. Lower urinary tract symptoms are often broadly classified into clinical syndromes/entities such as overactive bladder (OAB), underactive bladder (UAB), UI, nocturia, dysfunctional voiding, or genito-urinary fistulae.

Lower urinary tract symptoms are an extremely common complaint in the female population in every part of the world [2-5]. It causes a great deal of distress and embarrassment [6], as well as significant costs to both individuals and societies. Estimates of prevalence vary according to the definition and the population studied. However, there is universal agreement about the importance of the problem in terms of human suffering and economic cost [7].

1.1.Aim and objectives

These Guidelines from the European Association of Urology (EAU) Working Panel on Non-neurogenic Female LUTS are written by a multidisciplinary group, primarily for urologists, but are likely to be referred to by other professional groups. They aim to provide sensible and practical evidence-based guidance on the clinical problems associated with female LUTS rather than an exhaustive narrative review. Such reviews for UI and other LUT syndromes are already available from the International Consultation on Incontinence (ICI) [8] and other sources, so these EAU Guidelines do not describe the causation, basic science, epidemiology and psychology of LUTS/UI in detail. The focus of these Guidelines is entirely on assessment and treatment, reflecting clinical practice. These guidelines also do not consider women with LUTS caused by neurological disease, or LUTS occurring in children, as this is covered by complementary EAU Guidelines [9,10].

The current Guidelines provide:

  • A clear description of the assessment and treatment of common clinical problems. This can provide the basis for thinking through a patient’s management and for planning and designing clinical services;
  • A brief but authoritative summary of the current state of evidence on clinical topics, complete with references to the original sources;
  • Clear guidance on what to do or not to do, in most clinical circumstances. This should be particularly helpful in those areas of practice for which there is little, or no, high-quality evidence.

The latest edition of the guidelines has seen a significant expansion of scope from ‘urinary incontinence’ to ‘non- neurogenic female LUTS’. The primary consideration here was to include the significant population of women with functional urological conditions not necessarily associated with UI that were hitherto not accounted for in previous guidelines. Secondary considerations were to align more cohesively with the existing Non-neurogenic Male LUTS Guideline. As a consequence of the anatomical and physiological differences between the male and female LUT, the prevalence, pathophysiology, diagnostic approach and management of male and female LUTS differ widely. For that reason, the EAU Guidelines Office decided to provide gender-specific guidelines on LUTS and UI going forward. As a result, the section on post-prostatectomy UI has been moved to the Non-neurogenic Male LUTS Guideline. This reconfiguration has also seen some additional sections added to this Guideline (including non-obstetric fistulae, female bladder outlet obstruction [BOO], UAB and nocturia) and over the course of the next two or three iterations the scope is likely to widen further.

1.2.Panel composition

The EAU Non-neurogenic Female LUTS Panel consists of a multidisciplinary group of experts, including urologists, a uro-gynaecologist, a urodynamic scientist 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: https://uroweb.org/guideline/non-neurogenic-female-luts/.

The Panel acknowledge the support of Mrs. M. de Heide (Bekkenbodem4all), Mrs. T. van den Bos (Bekkenbodem4All), Mrs. M.L van Poelgeest-Pomfret (World Federation for Incontinence and Pelvic Problems [WFIP]) and Dr. H. Cobussen-Boekhorst (nurse practitioner) in the development of these guidelines.

1.3.Available publications

A quick reference document (Pocket Guidelines) is available, both in print and as an app for iOS and Android devices. These are abridged versions which require consideration together with the full text versions. All documents are accessible through the EAU website: https://uroweb.org/guideline/non-neurogenic-female-luts/.

1.4.Publication history

The first EAU Urinary Incontinence Guidelines were published in 2001. The guideline has been modified since to broaden its scope specifically to include other female LUTS as of 2021.