Excerpt

This guidance is a partial update of National Institute for Health and Care Excellence (NICE) clinical guideline 40 (published October 2006) and will replace it.

New and updated recommendations have been included based on evidence of the clinical and cost effectiveness of: Antimuscarinic drugs: darifenacin, darifenacin – extended release, fesoterodine – modified release, oxybutinin, oxybutynin – modified release, oxybutynin – transdermal, oxybutynin – topical gel, propiverine, propiverine – extended release, solifenacin, tolterodine, tolterodine – extended release, trospium, trospium – extended release; Percutaneous sacral nerve stimulation (P-SNS) compared with either no active treatment or placebo; Percutaneous posterior tibial nerve stimulation (P-PTNS) compared with either no active treatment or placebo; Transcutaneous posterior tibial nerve stimulation (T-PTNS) compared with either no active treatment or placebo; Transcutaneous sacral nerve stimulation (T-SNS) compared with either no active treatment or placebo; A comparison of T-SNS, T-PTNS and P-PTNS (if these treatments are found to be effective compared with no treatment or placebo); Botulinum toxin A compared with placebo in women with overactive bladder (OAB) caused by detrusor overactivity; Pharmacological treatment compared with neuromodulation in all women with overactive bladder; Pharmacological treatment compared with neuromodulation and botulinum toxin A in women with OAB caused by detrusor overactivity only; Surgical approaches for mid-urethral procedures in women undergoing their primary surgical tape procedure: retropubic bottom up, retropubic top down, transobturator inside out, transobturator outside in, single incision; Interventions for women for whom the primary tape procedure has failed: conservative management, looking only at: lifestyle interventions, specifically weight loss, fluid management and smoking cessation and physical therapy, specifically pelvic floor muscle training, repeat tape procedure, fascial sling, colposuspension.

Contents

• 1. Guideline summary
  • 1.1. Guideline development group membership, NCC-WCH staff and acknowledgements (Original 2006 guideline)
  • 1.2. Guideline development group membership, NCC-WCH staff and acknowledgements (2013 partial update)
  • 1.2. Foreword
  • 1.3. Care pathway
  • 1.4. Key priorities for implementation
  • 1.5. Recommendations
  • 1.6. Key research recommendations
  • 1.7. Research recommendations
  • 1.8. Other versions of the guideline
  • 1.9. Schedule for updating the guideline
• 2. Introduction
  • 2.1. Urinary incontinence
  • 2.2. Aim of the guideline
  • 2.3. Areas outside the remit of the guideline
  • 2.4. For whom is the guideline intended?
  • 2.5. Who has developed the guideline?
  • 2.6. Other relevant documents
  • 2.7. Related NICE guidance
• 3. Guideline development methodology
  • 3.1. 2006 Guideline method
  • 3.2. Schedule for updating the guideline
  • 3.3. Methodology for 2013 Update
• 4. Assessment and investigation
  • 4.1. Introduction
  • 4.2. History taking and physical examination
  • 4.3. Pelvic floor muscle assessment
  • 4.4. Assessment of prolapse
  • 4.5. Urine testing
  • 4.6. Assessment of residual urine
  • 4.7. Referral
  • 4.8. Symptom scoring and quality-of-life assessment
  • 4.9. Bladder diaries
  • 4.10. Pad testing
  • 4.11. Urodynamic testing
  • 4.12. Other tests of urethral competence
  • 4.13. Cystoscopy
  • 4.14. Imaging
  • 4.15. Information provision
• 5. Conservative management
  • 5.1. Introduction
  • 5.2. Lifestyle interventions
  • 5.3. Physical therapies
  • 5.4. Behavioural therapies
  • 5.5. Neurostimulation
  • 5.6. Alternative conservative management options
  • 5.7. Complementary therapies
  • 5.8. Preventive use of conservative therapies
  • 5.9. Optimal sequence and timescales for conservative therapies
  • 5.10. Progression of treatment
• 6. Pharmacological therapies
  • 6.1. OAB drugs
  • 6.2. Desmopressin
  • 6.3. Diuretics
  • 6.4. Duloxetine
  • 6.5. Oestrogens
• 7. Multidisciplinary team
  • 7.1. Introduction
  • 7.2. Multidisciplinary team
• 8. Invasive procedures for overactive bladder
  • 8.1. Introduction
  • 8.2. Botulinum toxin
  • 8.3. Percutaneous sacral nerve stimulation
  • 8.4. Augmentation cystoplasty
  • 8.5. Urinary diversion
  • 8.6. Detrusor myectomy
  • 8.7. Vanilloid receptor agonists
  • 8.8. Sequence of surgical procedures for overactive bladder – economic evaluation
• 9. Surgical procedures for stress urinary incontinence
  • 9.1. Introduction
  • 9.2. Procedures to suspend the vaginal wall
  • 9.3. Operations to augment sphincter closure
  • 9.4. The effect of hysterectomy on continence
  • 9.5. Secondary procedures for women who have had previous surgery
• 10. Competence of surgeons performing operative procedures for urinary incontinence in women
  • 10.1. Introduction
  • 10.2. Achieving competence
  • 10.3. Maintaining and measuring expertise and standards for practice
• 11. References
• 12. Abbreviations and glossary
• Appendix A. Scope
• Appendix B. Stakeholders
• Appendix C. Declarations of interest
• Appendix D. Review protocols
• Appendix E. Search strategies
• Appendix F. Summary of identified studies
• Appendix G. Excluded studies
• Appendix H. Evidence tables
• Appendix I. GRADE tables
• Appendix J. Key priorities for research
• Appendix K. Deleted 2006 text
• Appendix L. Proposed changes to original recommendations
• Appendix M. Network meta-analysis
• Appendix N. The cost effectiveness of overactive bladder drugs for wet overactive bladder with incontinence
• Appendix O. Overactive bladder procedures – health economics
• Appendix P. Guideline questions (2006)
• Appendix Q. Findings of urinary history taking compared with urodynamics (2006)
• Appendix R. Economic evidence for urodynamics (2006)
• Appendix S. Costing first-line conservative treatments for urinary incontinence (2006)
• Appendix T. Cost effectiveness analysis for duloxetine (2006)
• Appendix U. A partial cost–consequence analysis for surgical treatment options for overactive bladder (2006)
• Appendix V. GDG survey on draft clinical questions – feedback

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers