2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association

Abstract

A dult urinary incontinence (UI) is a highly prevalent condition, and one which can have a major impact on patients' quality of life. It is also a major focus of a urologist's workload. As a result, the Canadian Urological Association (CUA), with the aid of its Guidelines Committee, commissioned the development of a practice guideline document in 2005 first authored by Dr. Jacques Corcos. As per the CUA Guidelines Committee's mandate, all guidelines are subject to revision after 5 years. Methodology A comprehensive review of the studies published from January 2005 and November 2011 was performed using PubMed, MEDLINE and The Cochrane Library databases. In addition, the bibliographies of all relevant articles were searched to avoid exclusion of significant articles. Focus was on systematic reviews, meta-analyses and evidencebased recommendations, when available. Data from the latest consensus of the International Continence Society (ICS), the International Consultation on Incontinence (ICI), the International Urogynecological Association (IUGA), the American Urological Association (AUA), the European Association of Urology (EAU), the Urinary Incontinence Treatment Network (UITN), the Society of Obstetricians and Gynecologists of Canada (SOGC) and the American Congress of Obstetricians and Gynecologists (ACOG) were also incorporated. This review does not address U I in children or patients with neurogenic bladder. All articles were reviewed using the Evidence-Based Medicine (EBM) levels, with a Modified Oxford grading System (Appendix A).

Periurethral bulking agents for female stress urinary incontinence in Canada

“…The efficacy and durability of bulking agents is inferior to surgical treatment for SUI and repeat injections may be required. 1 The lower efficacy and durability of bulking agents is balanced by low treatment morbidity and a favourable adverse event profile when compared to surgical management.…”

“…A variety of management options are available for appropriately selected patients; these range from pelvic floor physiotherapy to surgical methods. 1 Injectable urethral bulking agents fall along this spectrum and offer a less invasive treatment option for selected women with SUI. The use of bulking agents has been reported as early as 1900, when Gersuny described the injection of periurethral paraffin wax for SUI.…”

Management of patients with stress urinary incontinence after failed midurethral sling

“…6 MUS used for mixed urinary incontinence or urgency incontinence have lower success rates than when used for pure SUI. A retrospective review of 760 RPR procedures at eight-year followup demonstrates MUS cure rates of 85% in women with exclusive SUI compared to only 30% of those with an original diagnosis of mixed urinary incontinence.…”

Delirium following fesoterodine treatment for urgency incontinence in an 89-year old man

“…1 Antimuscarinic agents used to treat urgency incontinence may cause central nervous system (CNS) effects, such as delirium and cognitive decline. 2 Fesoterodine has a comparable efficacy to other antimuscarinic agents in urgency incontinence. 2 Fesoterodine is rapidly metabolized into its active metabolite 5-hydroxymethyl tolterodine (5-HMT).…”

“…2 Fesoterodine has a comparable efficacy to other antimuscarinic agents in urgency incontinence. 2 Fesoterodine is rapidly metabolized into its active metabolite 5-hydroxymethyl tolterodine (5-HMT). 5-HMT crosses the blood-brain barrier (BBB), but is actively transported out of the CNS by the P-glycoprotein (P-gp), which leads to a non-significant concentration in the CNS in an vivo animal model.…”