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Adult female urinary incontinence guidelines: a systematic review of evaluation guidelines across clinical specialties

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Abstract

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.

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Acknowledgements

The authors thank Ashley I. Thakur, MPH, of the Washington University Brown School for her contributions with abstract review and Dr. Deborah Frank, who assisted with manuscript editing. Dr. Lenger thanks the Washington University Mentored Training Program in Clinical Investigation.

Funding

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.

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology, and Women’s Health, Division of Female Pelvic Medicine and Reconstructive Surgery, The University of Louisville School of Medicine, Louisville, KY, USA

    Stacy M. Lenger

  2. Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis Center for Outpatient Health, 9th floor, Campus, Box 8064, St. Louis, MO, 63110, USA

    Stacy M. Lenger, Christine M. Chu, Chiara Ghetti & Jerry L. Lowder

  3. Washington University School of Medicine, Becker Medical Library, St. Louis, MO, USA

    Angela C. Hardi

  4. Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA

    H. Henry Lai

  5. Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA

    Ratna Pakpahan & Siobhan Sutcliffe

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  1. Stacy M. Lenger
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  2. Christine M. Chu
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Contributions

SM Lenger: Protocol/project development, data collection, data analysis, manuscript writing/editing.

CM Chu: Data collection, data analysis, manuscript writing/editing.

C Ghetti: Data collection, data analysis, manuscript writing/editing.

AC Hardi: Protocol/project development, data collection, manuscript writing.

HH Lai: Data collection, data analysis, manuscript writing/editing.

R Pakpahan: Data collection, data analysis, manuscript editing.

JL Lowder: Protocol/project development, data collection, data analysis, manuscript writing/editing.

S Sutcliffe: Protocol/project development, data collection, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Jerry L. Lowder.

Ethics declarations

Financial disclaimers and conflicts of interest

H. Henry Lai is part of a scientific study for Medtronic, part of a clinical trial for Allergan, and on the scientific advisory board for Aquonix, Teva, and Neuspera. The remaining authors report no conflicts of interest.

Paper presentation information

An abstract of this paper was presented as a poster at the Society of Gynecologic Surgeons 45th Annual Scientific Meeting (Tucson, AZ, March 31–April 3, 2019).

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Jerry L. Lowder and Siobhan Sutcliffe are co-senior authors of this article.

Supplementary Information

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Appendices

Appendix A.1

Table 6 History evaluation scoringa
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Appendix A.2

Table 7 Physical examination evaluation scoringa
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Appendix A.3

Table 8 Diagnostics evaluation scoringa
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Appendix A.4: Full search strategies.

The complete search strategy for Ovid-Medical was as follows: (((exp Urinary Incontinence/ OR exp. overactive bladder/) AND (exp Guideline/ OR exp. Practice Guideline/)) OR ((urinary incontinence.mp. OR urine incontinence.mp. OR bladder incontinence.mp. OR incontinentia urinae.mp. OR urinary leakage.mp. OR urine leakage.mp. OR overactive bladder.mp. OR bladder overactivity.mp. OR overactive detrusor.mp.) adj5 (guideline*.mp. OR committee opinion.mp. OR practice bulletin.mp. OR protocol*.mp.))). This resulted 230 abstracts on May 1, 2017. After limiting to English, 179 abstracts remained. On September 7, 2018 an updated search date limited 2017-present and limited to English resulted 26 abstracts. Each of the remaining searches followed a similar strategy.

The complete search strategy for Embase was as follows: (((‘urine incontinence’/exp. OR ‘overactive bladder’/exp) AND (‘practice guideline’/mj)) OR ((‘urinary incontinence’ OR ‘urine incontinence’ OR ‘bladder incontinence’ OR ‘incontinentia urinae’ OR ‘urinary leakage’ OR ‘urine leakage’ OR ‘overactive bladder’ OR ‘bladder overactivity’ OR ‘overactive detrusor’) NEAR/5 (guideline* OR ‘committee opinion’ OR ‘practice bulletin’ OR protocol*))). This resulted 524 results on May 1, 2017. After limiting to English, 430 abstracts remained. On September 7, 2018 an updated search date limited 2017 to present and limited to English resulted 73 abstracts.

On May 1, 2017, CINAHL was searched with the following strategy: ((((MH “Urinary Incontinence”) OR (MH “Overactive Bladder”)) AND (MH “Practice Guidelines”)) OR ((“urinary incontinence” OR “urine incontinence” OR “bladder incontinence” OR “incontinentia urinae” OR “urinary leakage” OR “urine leakage” OR “overactive bladder” OR “bladder overactivity” OR “overactive detrusor”) N5 (guideline* OR “committee opinion” OR “practice bulletin” OR protocol*))), with 250 results or 244 after limiting to English. On September 7, 2018 an updated search date limited April 1, 2017 to present and limited to Enligh resulted 17 abstracts.

On the same date, the following search strategy was used in Scopus: (TITLE-ABS-KEY (“urinary incontinence” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“urine incontinence” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“bladder incontinence” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“ incontinentia urinae “ W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“urinary leakage” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“urine leakage” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“overactive detrusor” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“overactive bladder” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“bladder overactivity” W/4 (guideline* or protocol))) OR (TITLE-ABS-KEY (“urinary incontinence” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“urine incontinence” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“bladder incontinence” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“incontinentia urinae” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“urinary leakage” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“urine leakage” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“overactive detrusor” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“overactive bladder” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“bladder overactivity” W/4 “committee opinion”)) OR (TITLE-ABS-KEY (“urinary incontinence” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“urine incontinence” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“bladder incontinence” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“incontinentia urinae” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“urinary leakage” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“urine leakage” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“overactive detrusor” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“overactive bladder” W/4 “practice bulletin”)) OR (TITLE-ABS-KEY (“bladder overactivity” W/4 “practice bulletin”)). Two-hundred results were obtained. On September 7, 2018 an updated search date limited 2017 to present and limited to English resulted 26 abstracts.

The Cochrane Library was searched using ((“urinary incontinence” OR “urine incontinence” OR “bladder incontinence” OR “incontinentia urinae” OR “urinary leakage” OR “urine leakage” OR “overactive bladder” OR “bladder overactivity” OR “overactive detrusor”) NEAR/5 (guideline* OR “committee opinion” OR “practice bulletin” OR protocol*)) with 57 results on May 1, 2017. MeSH headings did not change the number of results. Due to difficulties with the Cochrane Library interface, this database was not included in the updated search.

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Lenger, S.M., Chu, C.M., Ghetti, C. et al. Adult female urinary incontinence guidelines: a systematic review of evaluation guidelines across clinical specialties. Int Urogynecol J 32, 2671–2691 (2021). https://doi.org/10.1007/s00192-021-04777-z

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