TY - JOUR
T1 - Adult female urinary incontinence guidelines
T2 - a systematic review of evaluation guidelines across clinical specialties
AU - Lenger, Stacy M.
AU - Chu, Christine M.
AU - Ghetti, Chiara
AU - Hardi, Angela C.
AU - Lai, H. Henry
AU - Pakpahan, Ratna
AU - Lowder, Jerry L.
AU - Sutcliffe, Siobhan
N1 - Funding Information:
SS was supported by the Foundation for Barnes-Jewish Hospital, the Alvin J. Siteman Cancer Center (P30 CA091842), and the Institute of Clinical and Translational Sciences (UL1 TR002345). These funding sources were not involved in the research, collection, analysis, data interpretation, manuscript writing, or decision to submit the article for publication.
Publisher Copyright:
© 2021, The International Urogynecological Association.
PY - 2021/10
Y1 - 2021/10
N2 - Introduction and hypothesis: To systematically review evaluation guidelines of uncomplicated urinary incontinence (UI) in community-dwelling adult women to assess guidance available to the full range of providers treating UI. Methods: Systematic literature search of eight bibliographic databases. We included UI evaluation guidelines written for medical providers in English after January 1, 2008. Exclusion criteria: guidelines for children, men, institutionalized women, peripartum- and neurologic-related UI. A quantitative scoring system included assessed components and associated recommendation level and clarity. Results: Twenty-two guidelines met the criteria. All guidelines included: history taking, UI characterization, physical examination (PE) performance, urinalysis, and post-void residual volume assessment. At least 75% included medical and surgical history assessment, other disease process exclusion, medication review, impact on quality of life ascertainment, observing stress UI, mental status assessment, performing a pelvic examination, urine culture, bladder diary, and limiting more invasive diagnostics procedures. Fifty to 75% included other important evaluation components (i.e., assessing obstetric history, bowel symptoms, fluid intake, patient expectations/preferences/values, obesity, physical functioning/mobility, other PE [abdominal, rectal, pelvic muscle, and neurologic], urethral hypermobility, and pad testing. Less than 50% of guidelines included discussing patient treatment goals. Guidelines varied in level of detail and clarity, with several instances of unclear or inconsistent recommendations within the same guideline and evaluation components identified only by inference from treatment recommendations. Non-specialty guidelines reported fewer components with a lesser degree of clarity, but this difference was not statistically significant (p = 0.20). Conclusions: UI evaluation guidelines varied in level of comprehensiveness, detail, and clarity. This variability may lead to inconsistent evaluations in the work-up of UI, contributing to missed opportunities for individualized care.
AB - Introduction and hypothesis: To systematically review evaluation guidelines of uncomplicated urinary incontinence (UI) in community-dwelling adult women to assess guidance available to the full range of providers treating UI. Methods: Systematic literature search of eight bibliographic databases. We included UI evaluation guidelines written for medical providers in English after January 1, 2008. Exclusion criteria: guidelines for children, men, institutionalized women, peripartum- and neurologic-related UI. A quantitative scoring system included assessed components and associated recommendation level and clarity. Results: Twenty-two guidelines met the criteria. All guidelines included: history taking, UI characterization, physical examination (PE) performance, urinalysis, and post-void residual volume assessment. At least 75% included medical and surgical history assessment, other disease process exclusion, medication review, impact on quality of life ascertainment, observing stress UI, mental status assessment, performing a pelvic examination, urine culture, bladder diary, and limiting more invasive diagnostics procedures. Fifty to 75% included other important evaluation components (i.e., assessing obstetric history, bowel symptoms, fluid intake, patient expectations/preferences/values, obesity, physical functioning/mobility, other PE [abdominal, rectal, pelvic muscle, and neurologic], urethral hypermobility, and pad testing. Less than 50% of guidelines included discussing patient treatment goals. Guidelines varied in level of detail and clarity, with several instances of unclear or inconsistent recommendations within the same guideline and evaluation components identified only by inference from treatment recommendations. Non-specialty guidelines reported fewer components with a lesser degree of clarity, but this difference was not statistically significant (p = 0.20). Conclusions: UI evaluation guidelines varied in level of comprehensiveness, detail, and clarity. This variability may lead to inconsistent evaluations in the work-up of UI, contributing to missed opportunities for individualized care.
KW - Evaluation
KW - Guidelines
KW - Personalized medicine
KW - Systematic review
KW - Urinary incontinence
UR - http://www.scopus.com/inward/record.url?scp=85104960951&partnerID=8YFLogxK
U2 - 10.1007/s00192-021-04777-z
DO - 10.1007/s00192-021-04777-z
M3 - Article
C2 - 33881602
AN - SCOPUS:85104960951
SN - 0937-3462
VL - 32
SP - 2671
EP - 2691
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 10
ER -