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 surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented.

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

“…Cure rates are as high as 90 percent [ 10 ]. Transobturator tapes (TOTs) are similarly as effective as TVTs in the short and medium term [ 11 , 12 , 13 ]. However, TVTs are becoming more popular due to better long-term data and fewer postoperative complications [ 14 ].…”

“…However, TVTs are becoming more popular due to better long-term data and fewer postoperative complications [ 14 ]. TOTs are more often associated with groin pain and dyspareunia [ 8 , 11 , 12 ]. The use of mini slings could not become established and long-term data are missing [ 8 , 11 ].…”

“…TOTs are more often associated with groin pain and dyspareunia [ 8 , 11 , 12 ]. The use of mini slings could not become established and long-term data are missing [ 8 , 11 ]. Colposuspension, the previous standard treatment for SUI, has similarly high cure rates [ 15 ].…”

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

“…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 .…”

The Treatment Selection for a 36-Year-Old Woman With Stress Urinary Incontinence Using a Discrete Mathematical Approach: A Case Report

“…The selection of treatment for SUI and OAB requires consideration of various factors, such as the patient's age, severity, comorbidities, and desire for pregnancy [2]. While each country has established guidelines for the treatment of SUI based on the best available evidence, these guidelines do not cover all aspects of medical decision-making [8,[13][14][15][16][17][18][19][20]. All guidelines serve as tools for clinicians to make informed decisions about patient care, presenting various types of information, such as the importance of post-treatment follow-up and patient education.…”