title: [Guidelines concerning urinary incontinence in elderly: construction and validation of GRAPPPA algorithm].
abstract: OBJECTIVE
  Provide guidelines presented as an algorithm for practical evaluation and first line therapy of urinary incontinence in elderly.
  
  
  METHODS
  Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 40 experts quoting proposals, subsequently reviewed by an independent group of multidisciplinary experts (urologist, general practitioner, neurologist, gynecologist, geriatrist, specialist in physical medicine and rehabilitation).
  
  
  RESULTS
  By means of 3 rounds of interrogation of the expert panel, GRAPPPA algorithm was constructed. This algorithm take in account both evaluation and first line therapeutic options in the different type of incontinences observed in this population (urge, stress and mixed incontinence). Initial evaluation consists to track down urinary retention (and subsequently fecal stool impaction, use of anticholinergic or morphinic drugs), urinary tract infection and cognitive impairment. Haematuria, bladder-pelvic pain, history of radiotherapy or recent pelvic surgery, lead to refer the patient to a specialized unit. First line therapy is in all the cases pelvic floor training, use of local oestrogenotherapy and dietetic measures. In urge incontinence, anticholinergic drugs may be used.
  
  
  CONCLUSIONS
  Implementation of this algorithm may promote best practice in management of urinary incontinence in elderly.
authors.affiliation: Service de neuro-urologie, hôpital Tenon, AP-HP, GRC01 UPMC GREEN, 4, rue de la Chine, 75020 Paris, France. Electronic address: gerard.amarenco@tnn.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Amarenco
authors.affiliation: Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, 31059 Toulouse, France.
authors.forename: X
authors.initials: X
authors.lastname: Gamé
authors.affiliation: Centre de santé, 8, rue Neibecker, 93440 Dugny, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Petit
authors.affiliation: Service de gynécologie, CHU de Nîmes, place R.-Debré, 30029 Nîmes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Fatton
authors.affiliation: Service de gériatrie, CHU de Montpellier, avenue Charles-Flahault, 34295 Montpellier cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Jeandel
authors.affiliation: Service de médecine physique et de réadaptation, hôpital Rothschild, Paris AP-HP, GRC01 UPMC GREEN, 75571 Paris cedex 12, France.
authors.forename: G
authors.initials: G
authors.lastname: Robain
authors.affiliation: 17, place de l'Europe, 69006 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Scheiber-Nogueira
authors.affiliation: Service de gériatrie, CH Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Vetel
authors.affiliation: Service de gynécologie, CHU de Nîmes, place R.-Debré, 30029 Nîmes cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Mares
mesh_terms: D000368:Aged; D000465:Algorithms; D006801:Humans; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000628:therapy*
keywords: Algorithm; Algorithme; Elderly; Gériatrie; Hyperactivité vésicale; Incontinence urinaire; Incontinence urinaire d’effort; Overactive bladder; Personne âgée; Stress incontinence; Urgency; Urgenturie; Urinary incontinence
vernacular_title: Recommandations concernant l'incontinence urinaire de la personne âgée : construction et validation de l'algorithme décisionnel GRAPPPA.