[Current status of the diagnosis and treatment of urinary incontinence in Spain].
OBJECTIVE
To perform a review of the available literature about urinary incontinence (UI) epidemiology, diagnosis, treatment and results, mainly focusing on the stress UI, to expose the features about which may there be a consensus, and those that will need future research work.


METHODS
Systematic review of the available spanish bibliography about the proposed topic.


RESULTS
They prevalence of female UI in Spain varies between 20 and 50%, depending on age. There are no available data about incidence. The onset age of this disease has not been directly studied in any of the works reviewed, although from them it can be deduced that it is around 55 years. The patient with UI tends to hide the problem, and generally, doctors tend to not recognize it as a treatable pathology, so that supposedly there is a high prevalence off occult UI. UI is frequently related to many other pathologies. The diagnosis of UI in Spain is generally made following the international criteria collected in the available clinical practice guidelines, which describe the diagnostic process to be followed in detail. Diagnostic tests generally used in the diagnosis of UI have a sensitivity higher than 70% and a specificity around 65%. First choice treatment is conservative, including the use of physiotherapy by means of pelvic muscle exercises. It is considered that pharmacological treatment has not much effect, although it doesn't seem to have been investigated in depth in Spain. Surgery, in any of its various techniques, is the second choice treatment. Although studies on health results for UI are scarce, it is known that about one-quarter of all patients declare that their quality of life is affected. Economic studies about UI are very rare also and only offer results about some treatment items.


CONCLUSIONS
To better precise the incidence and prevalence of UI in Spain, the performance of population epidemiological studies seems necessary. The weakness of the diagnostic process of UI in Spain appears to be detection in the initial stages. It is also necessary to have studies evaluating conservative and pharmacological therapies currently performed; these studies would allow to establish comparisons with the surgical treatments usually performed. It is also necessary to have studies that include cost calculation for integrated costs for UI.
Rebollo Alvarez
Pablo
P
Unidad de Investigación de Resultados en Salud, Hospital Universitario Central de Asturias, Oviedo, España. pablo@hca.es
Espuña Pons
Montserrat
M
D006801:Humans; D013030:Spain; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*