Urinary incontinence in women.ppt

,urinaryincontinenceinwomen,october2006,changingclinicalpractice,niceguidelinesarebasedonthebestavailableevidencethedepartmentofhealthasksnhsorganisationstoworktowardsimplementingguidelinescompliancewillbemonitoredbythehealthcarecommission,needforthisguideline,urinaryincontinence(ui)commonlyaffectswomenofallagesitcanseriouslyaffectphysical,psychologicalandsocialwellbeingtheimpactonfamiliesandcarersmaybeprofoundestimatedcurrentcosttothenhsis233millionannually,uiiscommonbuthidden,estimated4millionwomenover40yearsregularlyincontinentinuk,urinaryincontinence,definedasinvoluntaryurinaryleakagemayoccurasaresultof:functionalabnormalitiesofthelowerurinarytractotherillnessesthesetendtocauseleakageindifferentsituations,howuipresents,spottheriskfactors,associationsandpossibleriskfactorsinclude:ageobstetricfactorssuchaspregnancyandparitymenopauseandhysterectomylowerurinarytractsymptomsfamilyhistoryandgeneticssmoking,dietandobesitycognitiveorfunctionalimpairment,treatmentpathway,whattheguidelinecovers,initialassessmentandinvestigationconservativemanagement,including:bladdertrainingsupervisedpelvicfloormuscletrainingpharmacologicaltherapymulti-channelcystometrysurgicaltreatmentoptionscompetenciesforsurgeonsperformingoperations,assessandinvestigate,assessusing:bladderdiariesurinedipsticktestpostvoidresidualvolumeconsider:fluidintakecaffeineconsumptionweightlosscategoriseandtreataccordingtotypeofui,supportinitialassessment,raiseawarenessofnicerecommendationsanddeveloptrainingopportunitiestofocusonkeyaspectsreviewandupdatelocalreferralandcarepathwaysuselocalmultidisciplinaryandspecialistteams,suchasintegratedcontinenceservicesusetoolsandquestionnairestosupportsymptomscoringandqualityoflifeassessment,manageconservatively,offertraininganddrugs,pelvicfloormuscletrainingeightcontractions,threetimesaday,3monthsminimumbladdertraining6weeksminimumantimuscarinicdrugsimmediate-releaseoxybutyninasfirstchoiceoffersupportandadviceforsideeffectsmulti-channelcystometry,ambulatoryurodynamicsorvideourodynamicsarenotrecommendedbeforestartingconservativetreatment,supportconservativechoices,reviewwhoisofferingsupervisedpelvicfloormuscletrainingandbladdertraininglocallyupdateprescribingpoliciesandformulariesinlinewiththeguidelineunderlinetheimportanceofsupportandadviceaboutsideeffectswhenprescribingmedicationforui,usecystometryifappropriate,multi-channelfillingandvoidingcystometryisrecommendedbeforesurgeryif:detrusoroveractivitysuspectedprevioussurgeryhasbeendoneforstressuioranteriorcompartmentprolapsesymptomssuggestvoidingdysfunctionalsoconsiderambulatoryurodynamicsorvideourodynamics,offersurgicalmanagement,ifconservativetreatmentshavefailedfor:overactivebladderwithorwithouturgeuioffer-sacralnervestimulationstressuioffer-retropubicmid-urethralproceduresalternativelycolposuspensionorrectusfascialsling,skillsforsurgeons,surgeonsundertakingsurgeryshould:receiveappropriatetraininginthemanagementofuiandassociateddisorders,orworkwithinamultidisciplinaryteamwiththistrainingregularlycarryoutsurgeryforuiinwomen,supportsurgicaloptions,reviewlocalaccess,consideruseofregionalservicesformallyassesscurrentpracticeforsurgeonsmaintainskillswithaminimumannualworkload-20casesperyearperprimaryprocedurenominateaclinicalleadwithineachsurgicalunitencouragesurgeonstosubmitoutcomestonationalregistries,treatmentpathway,targetresources,accesstoolsonline,costingtoolscostingreportcostingtemplateauditcriteriaimplementationadviceavailablefrom:.uk/cg040,accesstheguidelineonline,q.uk/cg040quickrefguideniceguidelinealloftherecommendatio