NICE publishes guideline on urinary incontinence
A guideline for the management
of urinary incontinence in women has been published this week by the National Institute for Health and Clinical Excellence.
The new guideline provides recommendations on the diagnosis of urinary
incontinence, treatments for the condition and competencies expected
of surgeons performing procedures.
In its guideline NICE recommends that duloxetine should not be used as
a first-line treatment for women with stress urinary incontinence.
The guideline also says: “Duloxetine should not routinely be used
as a second-line treatment for women with stress UI, although it may
be offered as second-line therapy if women prefer pharmacological to
surgical treatment or are not suitable for surgical treatment. If duloxetine
is prescribed, women should be counselled about its adverse effects.”
The following key priorities for the conservative (non-surgical) management
of the condition are offered by NICE:
· A trial of supervised pelvic floor muscle training of at least three
months’ duration should be offered as first-line treatment to women
with stress or mixed urinary incontinence.
· Bladder training lasting for a minimum of six weeks should be offered
as first-line treatment to women with urge or mixed urinary incontinence.
· Immediate release non-proprietary oxybutynin should be offered to women
with overactive bladder syndrome or mixed urinary incontinence as first-line
drug treatment, if bladder training has been ineffective. If immediate
release oxybutynin is not well tolerated, darifenacin [due to be launched
in the UK this week], solifenacin, tolterodine, trospium or an extended
release or transdermal formulation of oxybutynin should be considered
as alternatives. Women should be counselled about the
adverse effects of antimuscarinic drugs.
· Pelvic floor muscle training should be
offered to women in their first pregnancy as a preventive strategy for
urinary incontinence.
Familial breast
cancer NICE has also published an update of its familial
breast cancer guideline. The updated
guideline recommends yearly magnetic
resonance imaging screening for some women aged between 20 and 49 years
if they have a high risk of breast cancer. Other recommendations on the
identification and care of patients at risk of familial breast cancer
remain the same. |
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