Expert panel recommendations on therapeutic and diagnostic management of urinary incontinence and overactive bladder in women

Abstract

The expert panel recommendations are issued in order to increase the number of patients with urinary incontinence and overactive bladder receiving appropriate care. The expert panel recommends that urologists, gynecologists and other physicians interested in the field of incontinence should diagnose and initially treat women with incontinence. Incontinence question should be actively asked during each physician visit and if the answer is positive it should be followed by detailed questionnaire aiming at disclosing at which occasion patient is loosing urine. The next step should be urogynecological examination and cough stress test. The panel recommends urine dipstick in all women and post void residual urine measurement only in women with voiding difficulties. Other tests, such as ultrasound, cystoscopy, urodynamics are not recommended during initial diagnostic procedure. The indications for referral are significant pelvic organ prolapse, haematuria, pain during micturition, recurrent incontinence and infections, suspicion of fistula. The initial management of stress urinary incontinence should include lifestyle interventions, and physiotherapy. Use of pessaries is acceptable in women who are not fit or do not want surgical therapy. Local estrogen therapy should only be used in women with urogenital atrophy. Duloxetin is an option in the pharmacological therapy of stress incontinence, but it doesn’t cure the disease. The ineffectiveness of initial procedure should be indication to surgery. Alphaadrenomimetic drugs are not recommended in the therapy of urinary incontinence. The initial management of overactive bladder and urgency incontinence should include lifestyle interventions, however fluid restrictions (if fluid load is less than 3000ml) are not recommended. The cornerstone of overactive bladder and urgency incontinence therapy remains the treatment with anticholinergic drugs. Drugs are only effective when used accordingly to the registered doses. The new generation anticholinergics are recommended over the old ones, especially in frail elderly patients and in patients with concomitant diseases, due to their better safety profile. The evaluation of antichplinergics efficacy should be performed after 2-3 months , than after 6 months.