Diagnosis and Therapy of Female Urinary Incontinence. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/091, January 2022)

Abstract

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as “Female stress urinary incontinence,” “Female urge incontinence” and “Use of Ultrasonography in Urogynecological Diagnostics” for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline “Urinary Incontinence in Adults” published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.

Surgical Procedures for the Treatment of Stress Urinary Incontinence (SUI) in the Light of the Updated FDA-Warning and its Effects on Practice Patterns in Germany between 2010 and 2021

“…Ford et al concluded that: "Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have [8]. Furthermore, there is a wide national consensus about offering the SAS proce-dure to women with SUI in Germany and the German speaking countries [1,5,6,12] even though alloplastic material is needed.…”

“…Different surgical approaches to insert suburethral alloplastic slings (SAS) (retropubic vs. transobturatorial) as well as different types of SAS (materials, inside-out vs. outside-in techniques) have emerged over the years 3 . Promising data on success, low complications and high long-term improvement of quality of life have given the SAS a “gold standard” status in many countries, such as Germany, Austria and Switzerland 1 4 5 6 7 8 .…”

Netzchirurgie in der Gynäkologie

“…Merke Der Einsatz alloplastischer Materialien in der Urogynäkologie bedarf sowohl einer sorgfältigen Indikationsstellung als auch einer umfassenden Aufklärung der Patientin über Vor-und Nachteile, Risiken und mögliche Komplikationen dieser Methoden. Merke Retropubische (TVT) und transobturatorische Bänder (TOT) zeigen im 5-Jahres-Vergleich zwar ähnliche Erfolgsraten, nach 8 Jahren scheint das retropubische TVT allerdings überlegen zu sein [11].…”

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

“…Since 2012 [ 67 , 68 ], the number of publications increased drastically. Retrospective and prospective original articles, RCTs, reviews and meta-analyses were published, and laser therapy was evaluated in expert opinions and guidelines [ 7 , 69 , 70 ]. The latest findings and publications are summarized below.…”

“…Generally, surgery is recommended after three months of unsuccessful conservative therapy [ 7 ]. The application of local estrogen before the intervention helps to improve tissue quality [ 8 ].…”