For the 2022 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 sections include:
- Section 4.1.4.1.5.6.2, Inclusion of data from the SR and metanalysis conducted by the panel on the benefits and potential harms of the surgical and non-surgical treatment options for the management of women with overactive bladder syndrome.
- Section 4.1.4.2.2, The addition of a SR and metanalysis on vibegron resulted in the alteration of the Summary of evidence and recommendation to include its use alongside mirabegron.
- A newly included section 4.2.4.1.5 Electroacupuncture, as part of conservative disease management for SUI.
- A newly included section 4.2.4.2.3 Adrenergic agonists, as part of the pharmacological management of SUI.
Specific changes resulting in new summary of evidence and recommendations include:
Section 3.9 Urinary biomarkers and microbiome:
Summary of evidence | LE |
There is insufficient evidence on the diagnostic accuracy and validity of urinary biomarkers for LUT disease in women. | 3 |
Differences in the urinary microbiome have been found to be associated with different types of LUT dysfunction in women, including UI, and with different responses to treatment. | 3 |
Recommendation | Strength rating |
Do not routinely use urinary biomarkers or estimation of the urinary microbiome in the diagnosis and management of LUT disease in women. | Strong |
Section 4.1.4.3.3 on Laser treatment of OAB:
Summary of evidence | LE |
Vaginal laser therapy shows minimal OAB symptom improvement in the short term, with minimal complications, however long-term efficacy and safety data are lacking. | 3 |
Recommendation | Strength rating |
Do not offer vaginal laser therapy to treat OAB symptoms outside of a well-regulated clinical research trial. | Strong |
Section 4.2.4.3.2.4 Laser treatment of SUI, resulting in a new summary of evidence and recommendation:
Summary of evidence | LE |
Several limitations have been noted in the current literature regarding vaginal laser treatment for SUI. These include variation in laser settings and protocols, short-term follow-up, lack of urodynamic evaluation, and poor reporting of appropriate objective measures and adverse events | 1b |
Recommendations | Strength rating |
Do not offer vaginal laser therapy to treat SUI symptoms outside of a well-regulated clinical research trial. | Strong |
Section 4.4.4.1.6 regarding intra-urethral inserts for underactive bladder:
Summary of evidence | LE |
Intra-urethral inserts/prostheses may be useful in selected patients as an alternative to CISC but existing research has highlighted issues with tolerance, infection and device migration. | 2b |