Selected Guidelines. (Featured CME Topic: Urinary Incontinence).

Selected Guidelines (*)

First International Consultation on Incontinence: Assessment and treatment recommendations. Abrams P. Lancet 2000; 355: 21532158 and WHO Health Publication Ltd, 1999.

* Medical experts from the International Consultation on Urological Diseases, the American Urologic Association, the European Association of Urology, and the International Continence Society assembled under the auspices of the World Health Organization to raise awareness and reach a consensus on universal treatment guidelines for urinary incontinence. Twenty-five committees evaluated the breadth and depth of the incontinence problem worldwide by examining issues ranging from the prevalence of bladder control problems to the economic and quality of life impact that bladder control problems have on a local, regional, national, and global level. The management recommendations are presented as nine algorithms divided into basic management (for all health care professionals) and specialized management.

First International Conference on Urinary Incontinence in the Elderly. Tsechkovski MS. World Journal of Urology 1998; 16 (suppl 1) S1S73.

* This conference was under the auspices of the World Health Organization in Bonn, Germany, in August 1997. A panel of experts were assembled to review evidence-based data on epidemiology of urinary incontinence in the elderly, the aging bladder, bladder overactivity, pelvic floor weakness, medical treatment, interdisciplinary care, and public health policies. Recommendations were based on extensive analysis of literature published and well-designed studies.

Female Stress Urinary Incontinence Clinical Guidelines: Panel Summary Report on Surgical Management of Female Stress Urinary Incontinence. Leach G, Dmochowski R.J Urol 1997;158:875-880.

* A panel of experts from the American Urologic Association analyzed the literature regarding surgical procedures for treating stress urinary incontinence in healthy females. The panel reviewed 5,322 articles, of which 282 were retrieved for detailed article review and data extraction. The data indicate that after 48 months, retropubic suspensions and slings appear to be more efficacious than transvaginal suspension. One strong limitation on the development of these recommendations was the lack of prospective, randomized controlled trials and the lack of standardized diagnostic criteria among studies.

Consensus Guidelines for the Promotion and Management of Continence by Primary Health Teams. Button D, Webb C. Journal of Advanced Nursing 1998;27:91-99.

* This project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health teams. A systematic review of literature published in English between 1990 and 1998 was done. Post-implementation of guidelines data confirmed the reluctance of incontinence sufferers to seek help for their condition. The severity of the urinary incontinence was found to be a key factor for determining help-seeking behavior.

Prevention of Urinary Incontinence, P97: A Consensus Statement at the International Continence Society in Yokohama, Japan, 1997. The Simmon Foundation for Continence, PO Box 815, Wilmette, IL 60091.

* The P97 Consensus Statement was the starting point document to stimulate discussion and debate in the area of urinary incontinence. The intent of this conference was to create a consensus statement that would guide and direct future clinical practice and research for the prevention of urinary incontinence. This conference was the first international meeting to focus on the prevention of incontinence. The meeting format was based on the model used for the 1988 NIH consensus development conference on adult urinary incontinence.

Managing Acute and Chronic Urinary Incontinence: Clinical Practice Guidelines. AHCPR Urinary Incontinence Guideline Update Panel. Rockville, Maryland. 1996.

* A panel of experts used an extensive review of scientific literature as well as expert judgment and group consensus to develop these guidelines. This quick reference guide is intended for health care providers who examine and treat adults with urinary incontinence. Included are a series of recommendations for identifying and evaluating urinary incontinence; use of behavioral, pharmacologic, and surgical treatment as well as supportive devices; and education of health professionals and the public. The panel found evidence in the literature that treatment of urinary incontinence can improve and cure most patients.

Standards of Efficacy for Evaluation of Treatment Outcomes in Urinary Incontinence: Recommendations of the Urodynamic Society. Blaivas J, Appell R. Neuro-urology and Urodynamics 1997; 16:145-147.

* The purpose of this document is to provide minimal standards by which the efficacy of therapy for urinary incontinence may be assessed. A committee of the Urodynamic Society developed the standards. They have been approved by both the American Urologic Association and the Urodynamic Society and are the official recommendations of those organizations. It is intended that these standards will be adopted by clinical and basic science researchers, the FDA, the peer review process, specialty and sub-specialty organizations, the health care industry, the regulatory agencies, and ultimately by clinicians.