Page 1 - 2012 Update: Guidelines for adult urinary incontinence

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cua guideline

2012 Update: Guidelines for Adult Urinary Incontinence Collaborative

Consensus Document for the Canadian Urological Association

Mathieu Bettez, MD; Le Mai Tu, MD, MSc; Kevin Carlson, MD, FRCSC; Jacques Corcos, MD, FRCSC;
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Jerzy Gajewski, MD, FRCSC; Martine Jolivet, MD, FRCSC; Greg Bailly, MD, FRCSC ‡
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* Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC; Department of Surgery, Division of Urology, University of Calgary, Calgary, AB; Department of Surgery,
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Division of Urology, McGill University, Montreal, QC; Department of Urology, Dalhousie University, Halifax, NS; Department of Surgery, Division of Urology, Université de Montréal, Montreal, QC
Cite as: Can Urol Assoc J 2012;6(5):354-63. http://dx.doi.org/10.5489/cuaj.12248
experience incontinence, making it a highly prevalent
condition, and one that is associated with a significant
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dult urinary incontinence (UI) is a highly prevalent economic burden. Incontinence can be classified into
condition, and one which can have a major impact three broad categories: stress, urge and mixed. Stress uri-
Aon patients’ quality of life. It is also a major focus of nary incontinence (SUI) is defined as leakage associated
a urologist’s workload. As a result, the Canadian Urological with exertion, sneezing or coughing, and represents 50%
Association (CUA), with the aid of its Guidelines Committee, of patients with incontinence in Canada. Urgency urinary
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commissioned the development of a practice guideline doc- incontinence (UUI) is leakage immediately preceded by or
ument in 2005 first authored by Dr. Jacques Corcos. As per associated with a sudden desire to void, representing 14%
the CUA Guidelines Committee’s mandate, all guidelines of patients. Mixed urinary incontinence (MUI) is charac-
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are subject to revision after 5 years. terized by the combination of UUI and SUI and represents
32% of patients in Canada. 1-3
Methodology Lower urinary tract symptoms (LUTS) include storage,
voiding and post- micturition symptoms. Although the term
A comprehensive review of the studies published from LUTS was originally used to describe male bladder outlet
January 2005 and November 2011 was performed using symptoms, this term can also be used to describe symptoms
PubMed, MEDLINE and The Cochrane Library databases. both in men and women. These may arise from the blad-
In addition, the bibliographies of all relevant articles were der or bladder outlet (including the prostate) conditions, in
searched to avoid exclusion of significant articles. Focus addition to non-urinary tract sources, such as polypharmacy,
was on systematic reviews, meta-analyses and evidence- polyuria, iatrogenic and psychogenic disorders. 2
based recommendations, when available. Data from the Overactive bladder (OAB) is a common condition defined
latest consensus of the International Continence Society as urgency, with (OAB wet) or without urgency incontinence
(ICS), the International Consultation on Incontinence (ICI), (OAB dry), usually associated with increased daytime fre-
the International Urogynecological Association (IUGA), quency and nocturia. In a recent Canadian population-based
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the American Urological Association (AUA), the European study, OAB symptoms were reported in 13.9% of respond-
Association of Urology (EAU), the Urinary Incontinence ents (13.1% of men and 14.7% of women). UI was reported
Treatment Network (UITN), the Society of Obstetricians by 28.8% of women with 68% having SUI, 21% MUI and
and Gynecologists of Canada (SOGC) and the American 11% UUI. In men, 5.4% of respondents had UI (26% SUI,
Congress of Obstetricians and Gynecologists (ACOG) were 15% MUI and 58% UUI). The prevalence of OAB symptoms
also incorporated. This review does not address UI in was similar in both sexes; however, OAB with UUI is more
children or patients with neurogenic bladder. All articles common in women (7.1% vs. 3.3%). Furthermore, OAB
were reviewed using the Evidence-Based Medicine (EBM) symptoms are more significant with increasing age (23.8%
levels, with a Modified Oxford grading System (Appendix A). for >60 years old vs. 12.2% for <60 years old.) 4
Less common categories of urinary incontinence include
Introduction total incontinence (associated with urinary tract fistula or
ectopic ureter), functional (associated with psychiatric or
UI can be defined as a complaint of any involuntary leakage mobility disorder), uncategorized, overflow, post-micturition
of urine. It is estimated that 3.3 million (10%) Canadians dribble, radiotherapy and climacturia.

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