Uro-6. Is there a need for a simpler algorithm for the management of female UI?

Urinary incontinence (UI) is a prevalent and bothersome disorder for many women, but few women seem to discuss UI with their primary care providers (PCPs). Unfortunately PCPs rarely ask women about UI, maybe because they do not feel prepared enough to manage UI or do not have the time to implement the current complex algorithms for diagnosis and management. Because implementation of current UI recommendations has proved to be difficult and perceived as too complex, we suggest a simpler algorithm with easy assessment and evidence-based treatment to be used by the PCPs with limited UI experience. Based on a recent evaluation of national and international recommendations for the initial management of female UI, we developed a simpler UI algorithm. National recommendations for initial UI management have been provided by the Agency for Health Care Policy and Research (AHCPR/AHRQ) web site, the American College of Obstetricians and Gynecologists (ACOG) bulletin, and the American Academy of Family Physicians (AAFP) monograph. Today the recommendations from the AHRQ and the ACOG are >5 years old and there are no plans to update them. These recommendations, the AAFP 2002 monograph and the International Consultation of Incontinence (ICI 2001) are, for the most part, in general agreement about assessment, but suggested treatments in many instances are not consistent and aligned. A simpler assessment should identify women with UI who need specialized management. Concurrent diseases, medication contributing to incontinence, abdominal masses, fecal impaction and bladder infection need to be identified. A short questionnaire may be sufficient to assess types and severity of UI symptoms and treatment should be limited to evidence-based procedures. There seems to be a need for a simpler and regularly updated algorithm for the initial management of women with UI. Simplification of algorithms, when safe, may encourage greater adaptation and compliance.

Lars Viktrup, MD, PhD, and Eric S. Meadows, PhD. Lilly Research Laboratories, Indianapolis, IN. Research Unit for General Practice, Frederiksborg County, Denmark. Lilly Research Laboratories, Indianapolis, IN.