Diagnosis and management of adult female stress urinary incontinence: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians.
Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.
Service de Gynécologie-Obstétrique, CHU Jean Bernard, F-86021 Poitiers cedex, France. fritel.xavier@orange.fr
Xavier
X
Fritel
Arnaud
A
Fauconnier
Georges
G
Bader
Michel
M
Cosson
Philippe
P
Debodinance
Xavier
X
Deffieux
Pierre
P
Denys
Philippe
P
Dompeyre
Daniel
D
Faltin
Brigitte
B
Fatton
François
F
Haab
Jean-François
JF
Hermieux
Jacques
J
Kerdraon
Pierre
P
Mares
Georges
G
Mellier
Nathalie
N
Michel-Laaengh
Cédric
C
Nadeau
Gilberte
G
Robain
Renaud
R
de Tayrac
Bernard
B
Jacquetin
D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011644:Puerperal Disorders / Q000628:therapy; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery / Q000628:therapy*