Both titles recognise training and expertise in treating urinary incontinence. The NICE GDG concluded that there was a requirement for the treatment plan to be validated by a group of qualified healthcare professionals who had not contributed to the prior treatment of the woman. The GRCG involved in the contextualised guideline agreed that resource constraints regarding training for ISC in most centres in New Zealand meant the requirement for every case requiring botulinum toxin type A to be discussed at the MDT, or for explicit training in ISC prior to the use of botulinum toxin type A was not practical.
The assessment of patients for use of botulinum toxin type A following local pathways was noted to work well and safely. These criteria are based on a combination of:. Surgeons undertaking fewer than 5 cases of any procedure annually should do so only with the support of their clinical governance committee; otherwise referral pathways should be in place within clinical networks. There is little robust evidence related to numbers of procedures annually [after appropriate training].
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This is addressed well in the NICE full guideline Mention is made of a survey in the UK in in order to establish the most appropriate number of procedures to maintain competency. In this survey, the majority specialist view was 10—20 procedures per year [among general gynaecologists and urologists] while urogynaecologists and gynaecologists with a special interest stated 20—50 procedures per year.
The GRCG is not aware of published evidence for these statements and in particular the relationship of numbers with clinical outcomes related to TVT.
Some recommendations can be made with more certainty than others. The original NICE Guideline Development Group made recommendations based on the trade-off between the benefits and harms of an intervention, taking into account the quality of the underpinning evidence. For some interventions, the Guideline Development Group is confident that, given the information it has looked at, most patients would choose the intervention.
The wording used in the recommendations in this guideline denotes the certainty with which the recommendation is made the strength of the recommendation. For all recommendations, NICE expects that there is discussion with the patient about the risks and benefits of the interventions, and their values and preferences.
This discussion aims to help them to reach a fully informed decision see also Patient-centred care. The bpac nz Guideline Review and Contextualisation Group have chosen to utilise the same conventions regarding wording for the strength of recommendations. This does not apply to any recommendations ending . The full NICE guideline, Urinary incontinence in women: the management of urinary incontinence in women see: www. The recommendations from this guideline have been incorporated into a NICE pathway see: pathways.
This can be accessed on the bpac nz website.
EAU Guidelines: Urinary Incontinence | Uroweb
See: www. This guidance represents the view of bpac nz in contextualising the NICE clinical guideline Urinary Incontinence: The management of urinary incontinence in women CG , which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.
About Guidelines. Urinary incontinence in women: the management of urinary incontinence in women. Introduction Patient-centred care Key priorities for implementation Recommendations 1. Published May Recommendations Tools and resources Download. Clinical guidelines: Help professionals and patients make decisions about the most appropriate treatment and care for specific clinical circumstances. Can be used to develop standards to assess the clinical practice of individual health professionals.
Can support the education and training of health professionals and others. Can improve communication between patients and health professionals.
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Stress UI is involuntary urine leakage on effort or exertion or on sneezing or coughing. Urgency UI is involuntary urine leakage accompanied or immediately preceded by urgency a sudden compelling desire to urinate that is difficult to delay.
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Mixed UI is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or coughing. Overactive bladder OAB is defined as urgency that occurs with or without urgency UI and usually with frequency and nocturia. These combinations of symptoms are suggestive of the urodynamic finding of detrusor overactivity, but can be the result of other forms of urethrovesical dysfunction. Patient-centred care This guideline offers best practice advice on the care of women with urinary incontinence.
Key priorities for implementation The following recommendations have been identified by the GRCG as priorities for implementation. Assessment of pelvic floor muscles Undertake routine digital assessment to confirm pelvic floor muscle contraction before the use of supervised pelvic floor muscle training for the treatment of UI. Absorbent products, urinals and toileting aids Absorbent products, hand held urinals and toileting aids should not be considered as a treatment for UI. Use them only as: a containment strategy pending definitive treatment an adjunct to ongoing therapy long-term management of UI only after treatment options have wbeen explored.
Indwelling urethral catheters Give careful consideration to the impact of long-term indwelling urethral catheterisation. Indications for the use of long-term indwelling urethral catheters for women with UI include: chronic urinary retention in women who are unable to manage intermittent self-catheterisation skin wounds, pressure ulcers or irritations that are being contaminated by urine distress or disruption caused by bed and clothing changes where a woman expresses a preference for this form of management.
General principles when using overactive bladder OAB medicines Before OAB medicine treatment starts, discuss with women: the likelihood of success and associated common adverse effects, and the frequency and route of administration, and that some adverse effects such as dry mouth and constipation may indicate that treatment is starting to have an effect, and that they may not see the full benefits until they have been taking the treatment for 4 weeks. Maintaining and measuring surgical expertise and standards for practice A national audit of continence surgery should be undertaken.
Recommendations The following guidance is based on the best available evidence. Original recommendation from Urinary Incontinence: The management of urinary incontinence in women CG Recommendation following contextualisation for this guideline Rationale for contextualisation 1. See 1. If detrusor overactivity is present but the woman does not wish to have invasive therapy, offer advice as described in recommendation 1. If detrusor overactivity is not present refer back to the MDT for further discussion concerning future management. This section must reflect the limited availability of each listed member.
Please see above comments 1. This reflects the lower initial starting dose used within New Zealand. Insertion of recommendation under 1. Effectiveness of the procedure in improving impact on life.
Clinical Management of Urinary Incontinence in Women
Surgeons undertaking fewer than 5 cases of any procedure annually should do so only with the support of their clinical governance committee; otherwise referral pathways should be in place within clinical networks 1. Surgeons undertaking fewer than 5 cases of any procedure annually should do so only with the support of their clinical governance committee; otherwise referral pathways should be in place within clinical networks There is little robust evidence related to numbers of procedures annually [after appropriate training].
Contextual relevance specific to registries for New Zealand Strength of recommendations Some recommendations can be made with more certainty than others. UK versions of this guideline The full NICE guideline, Urinary incontinence in women: the management of urinary incontinence in women see: www.
References See: www. See the NICE full guideline for details. Available from www. Available from: www. At the time of publication May , desmopressin tablets had marketing authorisation for nocturia but was not subsidised for nocturia. Desmopressin spray does not have marketing authorisation for nocturia, and is only subsidised for primary nocturnal enuresis under Special Authority in New Zealand.
At the time of publication May , Duloxetine did not have current marketing authorisation for UI in New Zealand, and was not a subsidised medicine. However, technological advances are frequent; therefore the choice of tape should include devices that are shown in future clinical trials to have equal or improved efficacy at equal or lower cost. Consultant Urologist, Christchurch Involved from first draft of guideline to publication.
Patient-perceived improvement was greatest for behavioral treatment Only It is often characterized by sudden large-volume urinary accidents that can lead to embarrassment and significant restriction of activities. Urge incontinence is commonly treated with drugs that inhibit detrusor contraction.
In addition to pharmacological approaches, behavioral treatments have been shown to improve bladder control by teaching patients new skills or habits. The present study is the first randomized clinical trial comparing the effectiveness of biofeedback-assisted behavioral treatment with both a standard drug treatment oxybutynin chloride and a control condition for the treatment of urge incontinence. In addition to testing the effectiveness of behavioral treatment, it is important to compare behavioral and drug treatment because the 2 interventions are both viable options with distinct advantages and disadvantages that need to be considered in clinical decision making.
Subjects were older, community-dwelling women with urge incontinence. They were recruited through local advertisements and professional referrals and screened by telephone for eligibility. Subjects had to be at least 55 years of age, be ambulatory, and describe urge incontinence occurring at least twice per week and persisting for at least 3 months.
Informed consent procedures approved by the university institutional review board were followed. The study was conducted between July 1, , and August 30, Potential subjects who met initial criteria were scheduled for a clinical evaluation to identify those who were not appropriate for treatment with oxybutynin or behavioral methods.