Articles

Guidelines

EAU Guidelines on Surgical Treatment of Urinary Incontinence

By: Malcolm G. Lucasa lowast , Ruud J.L. Boschb, Fiona C. Burkhardc, Francisco Cruzd, Thomas B. Maddene, Arjun K. Nambiara, Andreas Neisiusf, Dirk J.M.K. de Ridderg, Andrea Tubaroh, William H. Turneri and Robert S. Pickardj

European Urology, Volume 62 Issue 1, December 2012, Pages 1118-1129

Published online: 01 December 2012

Keywords: Mixed urinary incontinence, Stress urinary incontinence, Urge urinary incontinence, Botulinum toxin A, Sacral nerve stimulation, Bulking agents, Urinary incontinence, Practice-based, Surgical treatment, Colposuspension, Slings, Compression devices, Cystoplasty, EAU guidelines

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Abstract

Context

The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology.

Objective

We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience.

Evidence acquisition

Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system.

Evidence summary

The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report.

Conclusions

These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion.

Take Home Message

Patients choosing to undergo surgery for urinary incontinence expect a cure or substantial improvement. They need to balance the benefits of specific procedures against invasiveness and risks of harm. These guidelines provide evidence-based recommendations for practice to help urologists direct treatment choice.

Keywords: Mixed urinary incontinence, Stress urinary incontinence, Urge urinary incontinence, Botulinum toxin A, Sacral nerve stimulation, Bulking agents, Urinary incontinence, Practice-based, Surgical treatment, Colposuspension, Slings, Compression devices, Cystoplasty, EAU guidelines.

Footnotes

a Department of Urology, Morriston Hospital, Swansea, UK

b Department of Urology, UMC Utrecht, Utrecht, The Netherlands

c Department of Urology, University Hospital Bern, Bern, Switzerland

d Department of Urology, Faculty of Medicine, Porto, Portugal

e The Royal Liverpool University Hospital, Liverpool, UK

f Department of Urology, Universitätsmedizin, Mainz, Germany

g Department of Urology, University Hospital Leuven, Leuven, Belgium

h Department of Urology, Sant’ Andrea Hospital La Sapienza, Rome, Italy

i Department of Urology, Addenbrooke's Hospital, Cambridge, UK

j Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

lowast Corresponding author. Department of Urology, Morriston Hospital, Swansea, UK.

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