European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence

Arjun K Nambiar; Salvador Arlandis; Kari Bø; Hanny Cobussen-Boekhorst; Elisabetta Costantini; Monica de Heide; Fawzy Farag; Jan Groen; Markos Karavitakis; Marie Carmela Lapitan; Margarida Manso; Serenella Monagas Arteaga; Aisling Nic An Riogh; Eabhann O'Connor; Muhammad Imran Omar; Benoit Peyronnet; Veronique Phé; Vasileios I Sakalis; Néha Sihra; Lazaros Tzelves; Mary-Lynne van Poelgeest-Pomfret; Tine W L van den Bos; Huub van der Vaart; Christopher K Harding

doi:10.1016/j.eururo.2022.01.045

European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence

Eur Urol. 2022 Jul;82(1):49-59. doi: 10.1016/j.eururo.2022.01.045. Epub 2022 Feb 23.

Authors

Arjun K Nambiar¹, Salvador Arlandis², Kari Bø³, Hanny Cobussen-Boekhorst⁴, Elisabetta Costantini⁵, Monica de Heide⁶, Fawzy Farag⁷, Jan Groen⁸, Markos Karavitakis⁹, Marie Carmela Lapitan¹⁰, Margarida Manso¹¹, Serenella Monagas Arteaga¹², Aisling Nic An Riogh¹³, Eabhann O'Connor¹⁴, Muhammad Imran Omar¹⁵, Benoit Peyronnet¹⁶, Veronique Phé¹⁷, Vasileios I Sakalis¹⁸, Néha Sihra¹⁹, Lazaros Tzelves²⁰, Mary-Lynne van Poelgeest-Pomfret²¹, Tine W L van den Bos⁶, Huub van der Vaart²², Christopher K Harding²³

Affiliations

¹ Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK. Electronic address: arjunknambiar@gmail.com.
² Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
³ Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
⁴ Department of Urology, Radboud UMC, Nijmegen, The Netherlands.
⁵ Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
⁶ Bekkenbodem4All, Tiel, The Netherlands.
⁷ Department of Urology, Sohag University Hospital, Sohag, Egypt; Department of Urology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK.
⁸ Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁹ Department of Urology, Charing Cross Hospital, London, UK.
¹⁰ College of Medicine, Philippine General Hospital, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
¹¹ Department of Urology, Centro Hospitalar Universitário São João, Porto, Portugal.
¹² Department of Urology, University Hospital of San Agustín, Avilés, Spain.
¹³ Department of Urology, Cork University Hospital, Cork, Ireland.
¹⁴ Department of Urology, Beaumont Hospital, Dublin, Ireland.
¹⁵ University of Aberdeen, Aberdeen, UK; European Association of Urology, Arnhem, The Netherlands.
¹⁶ Department of Urology, University of Rennes, Rennes, France.
¹⁷ Department of Urology, AP-HP, Pitié-Salpêtrière Academic Hospital, Sorbonne University, Paris, France.
¹⁸ Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece.
¹⁹ Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁰ Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece.
²¹ World Federation of Incontinence and Pelvic Problems, Leiden, The Netherlands.
²² Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands.
²³ Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.

PMID: 35216856
DOI: 10.1016/j.eururo.2022.01.045

Abstract

Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guideline expands the remit to include these symptoms and conditions.

Objective: To summarise the diagnostic section of the non-neurogenic female LUTS guideline and the management of female overactive bladder (OAB), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI).

Evidence acquisition: New literature searches were carried out in September 2021 and evidence synthesis was conducted using the modified GRADE criteria as outlined for all EAU guidelines. A new systematic review (SR) on OAB was carried out by the panel for the purposes of this guideline.

Evidence synthesis: The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations.

Conclusions: Non-neurogenic female LUTS are an important cause of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion based on the best available evidence. This guideline serves to present this evidence to health care providers in an easily accessible and digestible format.

Patient summary: This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to diagnosis of these conditions, as well as the treatment of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.

Keywords: Conservative management; Diagnostics; European Association of Urology guidelines; Female lower urinary tract symptoms; Mixed urinary incontinence; Overactive bladder; Pharmacological management; Stress urinary incontinence; Surgical management; Urinary incontinence.

Publication types

Review
Systematic Review

MeSH terms

Female
Humans
Lower Urinary Tract Symptoms* / diagnosis
Lower Urinary Tract Symptoms* / etiology
Lower Urinary Tract Symptoms* / therapy
Urinary Bladder
Urinary Bladder, Overactive* / complications
Urinary Bladder, Overactive* / diagnosis
Urinary Bladder, Overactive* / therapy
Urinary Incontinence, Stress* / diagnosis
Urinary Incontinence, Stress* / therapy
Urinary Incontinence, Urge
Urology*