For the 2023 Non neurogenic Female LUTS Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature. A broad and comprehensive literature search, covering all sections of the Female LUTS Guidelines was performed including Medline, Embase and the Cochrane Libraries, with a focus on high-level evidence only (systematic reviews and meta-analysis). Additional references and text updates have been incorporated throughout the text, as a result of this search. Specific changes include:

Section 4.1.4.1.2.1; the addition of a new summary of evidence and upgrading the recommendation regarding the review of medication from weak to strong.

Summary of evidence	LE
There is little evidence that adjustment of specific medications for associated co-morbid conditions can alter existing symptoms of OAB.	3

Section 4.1.4.1.5.2 on Bladder training for overactive bladder has been expanded extensively with the addition of information from two new systematic reviews.
Update and expansion of section 4.1.4.1.5.4 and the inclusion of two new summary of evidence

Summary of evidence	LE
Posterior tibial nerve stimulation is more effective than antimuscarinics in reducing UUI episodes but with no difference in improving other OAB symptoms	1a
Transcutaneous PTNS is not inferior to percutaneous PTNS with regards to improvement in urinary urgency, frequency and quality of life scores.	1a

Expansion of section 4.1.4.1.2.1 on anticholinergic drugs and the inclusion of data from the SR conducted by the panel on the effectiveness of antimuscarinic drugs for the pharmacological management of overactive bladder syndrome, as well as the inclusion of three new summary of evidence.

Summary of evidence	LE
Anticholinergic drugs are effective in improving OAB symptoms, decreasing urinary urgency incontinence episodes, decreasing daily urgency and frequency episodes and increasing mean voided volumes, compared with placebo.	1a
Anticholinergic drugs caused higher adverse events than placebo including dry mouth, cognitive impairment and constipation	1a
The combination of antimuscarinics plus another treatment modality was more effective than antimuscarinics alone in improving OAB.	1a

Section 4.1.4.2.2 the addition of a SR, resulting in an update to the text and new summary of evidence and recommendation.

Summary of evidence	LE
Beta-3 agonists are as effective as antimuscarinics in the management of OAB but with lower dry mouth rates.	1a

Recommendations	Strength rating
Offer mirabegron as an additional therapy in patients who are inadequately treated with solifenacin 5mg	Weak

Section 4.1.4.2.5; the addition of a new SR on the nocebo effect of pharmacotherapy in patients with OAB.
Section 4.1.4.3; the inclusion of data from the SR conducted by the panel on onabotulinumtoxinA A resulting in two new summary of evidence.

Summary of evidence	LE
OnabotulinumtoxinA is more effective in curing UUI but similarly effective in reducing mean UUI episodes compared with antimuscarinics.	1a
OnabotulinumtoxinA is associated with higher rates of voiding dysfunction than antimuscarinics	1a

Inclusion of new RCT’s in section 4.2.4.1.3.2 and section 4.2.4.1.3.5.6 resulting in a new summary of evidence and recommendation

Summary of evidence	LE
There is low to moderate certainty evidence suggesting benefit of ES In patients with SUI. In addition, ES may be useful for learning a correct PFM contraction.	1b

Recommendations	Strength rating
Consider ES for treatment of SUI, or as an adjunct for teaching PFM contraction	Weak

Extensive discussion with the patient representatives resulted in a new recommendation included in section 4.2.4.3.1.2 regarding surgical treatment and shared decision-making.

Recommendations	Strength rating
Employ a shared decision-making approach when deciding on appropriate treatment for SUI	Strong

New data from an RCT resulted in a new summary of evidence and recommendation for section 4.2.4.3.2.5

Summary of evidence	LE
The rate of mesh exposure, repeat SUI surgery and dyspareunia at 3 years is higher for single incision slings (Ajust ® and Alits®) compared to conventional MUS	1b

Recommendations

Strength rating

Inform women who are being offered single incision slings (Ajust and Altis®), that short term efficacy appears equivalent compared to conventional MUS.

Strong

Section 4.4.4.5.1; two new summary of evidence for underactive bladder

Summary of evidence	LE
Adominal straining with relaxation of the pelvic floor muscle may improve bladder emptying but increases the risk of pelvic organ prolapse.	3
Pelvic floor muscle relaxation training may increase voiding episodes, decrease postvoid residual volume and voiding time.	3

Section 4.6.3, inclusion of new evidence from a SR, resulting in a new summary of evidence and recommendation

Summary of evidence	LE
Consider renal function, thyroid function, HbA1c and calcium level blood tests in the initial workup of women presenting with nocturia.	2

Recommendations	Strength rating
Consider screening for sleep disorders and performing renal function, thyroid function, HbA1c and calcium level blood tests in the initial workup of women presenting with nocturia as predominant symptom.	Strong

Update on recommendation 4.7.5 from warning patients that the benefit of combined surgery for POP and SUI may be outweighed by the increased risk of adverse events; to not offering concomitant anti incontinence surgery at the time of abdominal prolapse surgery.
New summary of evidence and recommendations for section 4.8.3 on the diagnostic evaluation of urogenital fistula.

Summary of evidence	LE
As for any LUTS, history taking and focused physical examination with direct visual inspection are essential parts of urinary fistula diagnostic evaluation.	3
Cystoscopy and retrograde bladder filling with a coloured fluid with placement of a tampon into the vagina to identify staining facilitate diagnosis of VVF.	3
Contrast-enhanced CT with late excretory phase reliably diagnoses urinary fistulae and provides information about ureteric integrity	3
Magnetic resonance imaging, in particular with T2 weighting, also provides diagnostic information regarding fistulae	3

Recommendations	Strength rating
Take a complete medical history and perform a focused physical examination including direct visual inspection for evaluation of women with suspicion of urinary fistula	Strong
Use cystoscopy and retrograde bladder filling with a coloured fluid to confirm the diagnosis of urinary fistula	Weak
Contrast-enhanced CT with late excretory phase and Magnetic resonance imaging can be used in cases where the diagnosis of urinary fistula is challenging or to provide additional diagnostic information	Weak

Section 4.9.5; a new recommendation for urethral diverticulum.

Recommendations	Strength rating
Use MRI for diagnosis and characterisation of urethral diverticula, with urethroscopy, VCUG and ultrasound.	Weak