1. INTRODUCTION
Lower urinary tract symptoms (LUTS) encompass storage, voiding and post-micturition symptoms [1]. Storage symptoms 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-micturition leakage 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 genitourinary fistulae.
Lower urinary tract symptoms are common in women [2-5] and cause a great deal of distress and embarrassment [6], as well as significant costs to both individuals and society [7]. Estimates of prevalence vary according to the definition and population studied. However, there is universal agreement about the importance of the problem in terms of human suffering and economic cost [7]. The panel regards the sustainability and environmental impact of interventions (such as materials for pads or catheters) for LUTS as an important consideration when deciding on treatments [8].
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. The guidelines 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) [9] and other sources. These EAU Guidelines do not describe the causation, basic science, epidemiology and pathophysiology of LUTS/UI in detail. The focus of these guidelines is on assessment and treatment, reflecting clinical practice, and they do not consider women with LUTS caused by neurological disease, or LUTS occurring in children, as these are covered by complementary EAU Guidelines [10,11].
The current guidelines provide:
- A clear description of the assessment and treatment of common clinical problems. This can provide the basis for both individual patient 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 in those areas of practice for which there is little or no high-quality evidence utilising both expert clinician and patient representative opinion.
In recent years the guideline has seen a significant expansion of scope from UI to non-neurogenic female LUTS. The primary consideration here is 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 are to align more cohesively with the existing Non-neurogenic Male LUTS Guidelines. 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 may differ widely.
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, a physiotherapist, a functional urology nurse practitioner, and patient advocates. All experts involved in the production of this document have submitted potential conflict of interest statements that can be viewed on the EAU website: https://uroweb.org/guidelines/non-neurogenic-female-luts/panel.
1.3. Available publications
A quick reference document, the Pocket Guidelines, is available in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available.
All documents are accessible through the EAU website Uroweb: https://uroweb.org/guideline/non-neurogenic-female-luts/.
An EAU Guidelines App for iOS and Android devices is also available containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets and links to the extended guidelines.
1.4. Publication history
The first EAU Urinary Incontinence Guidelines were published in 2001. The guidelines have been modified since 2021 to broaden its scope, specifically to include other female LUTS. All sections of the previous (2023) Female LUTS Guidelines have been fully updated following a full literature search.