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1、,Urinary incontinence in women,October 2006,Changing clinical practice,NICE guidelines are based on the best available evidenceThe Department of Health asks NHS organisations to work towards implementing guidelines Compliance will be monitored by the Healthcare Commission,Need for this guideline,Uri
2、nary incontinence(UI)commonly affects women of all agesIt can seriously affect physical,psychological and social wellbeingThe impact on families and carers may be profoundEstimated current cost to the NHS is 233 million annually,UI is common but hidden,Estimated 4 million women over 40 years regular
3、ly incontinent in UK,Urinary incontinence,Defined as involuntary urinary leakageMay occur as a result of:functional abnormalities of the lower urinary tractother illnessesThese tend to cause leakage in different situations,How UI presents,Spot the risk factors,Associations and possible risk factors
4、include:ageobstetric factors such as pregnancy and paritymenopause and hysterectomylower urinary tract symptomsfamily history and geneticssmoking,diet and obesitycognitive or functional impairment,Treatment pathway,What the guideline covers,Initial assessment and investigation Conservative managemen
5、t,including:bladder training supervised pelvic floor muscle training pharmacological therapyMulti-channel cystometrySurgical treatment optionsCompetencies for surgeons performing operations,Assess and investigate,Assess using:bladder diariesurine dipstick testpost void residual volumeConsider:fluid
6、intake caffeine consumptionweight lossCategorise and treat according to type of UI,Support initial assessment,Raise awareness of NICE recommendations and develop training opportunities to focus on key aspects Review and update local referral and care pathwaysUse local multidisciplinary and specialis
7、t teams,such as integrated continence servicesUse tools and questionnaires to support symptom scoring and quality of life assessment,Manage conservatively,Offer training and drugs,Pelvic floor muscle trainingEight contractions,three times a day,3 months minimumBladder training 6 weeks minimumAntimus
8、carinic drugs Immediate-release oxybutynin as first choice Offer support and advice for side effectsMulti-channel cystometry,ambulatory urodynamics or videourodynamics are not recommended before starting conservative treatment,Support conservative choices,Review who is offering supervised pelvic flo
9、or muscle training and bladder training locally Update prescribing policies and formularies in line with the guidelineUnderline the importance of support and advice about side effects when prescribing medication for UI,Use cystometry if appropriate,Multi-channel filling and voiding cystometry is rec
10、ommended before surgery if:detrusor overactivity suspectedprevious surgery has been done for stress UI or anterior compartment prolapsesymptoms suggest voiding dysfunctionAlso consider ambulatory urodynamics or videourodynamics,Offer surgical management,If conservative treatments have failed for:ove
11、ractive bladder with or without urge UI offer-sacral nerve stimulation stress UI offer-retropubic mid-urethral procedures alternatively colposuspension or rectus fascial sling,Skills for surgeons,Surgeons undertaking surgery should:receive appropriate training in the management of UI and associated
12、disorders,orwork within a multidisciplinary team with this trainingregularly carry out surgery for UI in women,Support surgical options,Review local access,consider use of regional servicesFormally assess current practice for surgeonsMaintain skills with a minimum annual workload-20 cases per year p
13、er primary procedure Nominate a clinical lead within each surgical unitEncourage surgeons to submit outcomes to national registries,Treatment pathway,Target resources,Access tools online,Costing toolscosting reportcosting templateAudit criteriaImplementation adviceAvailable from:www.nice.org.uk/CG04
14、0,Access the guideline online,Quick reference guide a summary www.nice.org.uk/CG040quickrefguideNICE guideline all of the recommendations www.nice.org.uk/CG040niceguidelineFull guideline all of the evidence and rationale www.nice.org.uk/CG040fullguidelineUnderstanding NICE guidance a plain English version www.nice.org.uk/CG040publicinfo,
