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Federal guidelines for the management of urinary incontinence in the United States: Which patients should undergo urodynamic testing?

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Abstract

In 1992, the United States Agency for Health Care Policy and Research (AHCPR) proposed a guideline for the management of adults with urinary incontinence. The purpose of this study is to evaluate the criteria proposed by the AHCPR for the selective use of urodynamic testing in women complaining of stress incontinence. In order to examine the efficacy of these criteria, we retrospectively determined urodynamic diagnoses for 101 women presenting with the complaint of stress incontinence. These were then compared to the AHCPR recommendations for each subject's management. We found that the AHCPR algorithm would have recommended treatment without urodynamic testing for 65% of the population. If the AHCPR guideline had been followed, 32% of the overall population could have received inappropriate treatment. These results suggest that the implementation of the AHCPR guideline could result in inappropriate treatment for onethird of women presenting with symptoms of stress incontinence.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center, 701 E 28th Street, #212, 90806, Long Beach, CA, USA

    V. L. Handa, J. K. Jensen & D. R. Ostergard

  2. University of California, Irvine, California, USA

    V. L. Handa, J. K. Jensen & D. R. Ostergard

Authors
  1. V. L. Handa
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  2. J. K. Jensen
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  3. D. R. Ostergard
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Editorial Comment: The federal guidelines for the management of urinary incontinence in the United States emphasize medical management prior to any diagnostic urodynamic studies beyond those that can be obtained by a physical examination and prior to surgical management. The guidelines are not adequate to triage patients for the therapy of urinary incontinence, as is pointed out by this article. This has been recognized at a federal level as well, and new guidelines are being prepared. It is not anticipated that they will differ to any great degree with respect to the need for medical management prior to any definitive urodynamic testing or surgical therapy. Hopefully the new guidelines will be more useful in the triage of patients to earlier urodynamic testing in those cases where medical management will predictably fail, and more appropriate therapy for incontinence can be instituted from the beginning.

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Handa, V.L., Jensen, J.K. & Ostergard, D.R. Federal guidelines for the management of urinary incontinence in the United States: Which patients should undergo urodynamic testing?. Int Urogynecol J 6, 198–203 (1995). https://doi.org/10.1007/BF01894262

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  • DOI: https://doi.org/10.1007/BF01894262

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