盧致誠 范文宙 鄭哲舟
奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科
Comparison of algorithms in the latest clinical practice guidelines for female incontinence between Taiwan urological association and others
Chih-Cheng Lu, Wen-Chou Fan, Tse-Chou Cheng
Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan
This study is to compare the clinical practice guidelines (CPGs) in managing female incontinence between Taiwan and others in the world. We focused on the algorithms and non-surgical management for female incontinence.
Materials and Methods:
The printed and online materials in medical guidelines or consensus for female incontinence by Taiwan Urological Association (TUA) and others were reviewed. Several statements were compared including published date, revision history, patient selection, diagnostic methods, and especially the non-surgical management.
In addition to the CPG by TUA, the American College of Physicians (ACP) and reviews from British Medical Journal (BMJ) were collected. The first and latest edition of CPG for female lower urinary tract symptoms (LUTS) by TUA was published in August 2014. The CPG by ACP and reviews from BMJ were published in September 2014. For stress incontinence but not urgent incontinence, pelvic-floor muscle training was recommended as first-line treatment in ACP, but not clearly recommended by TUA. Reducing body mass index below 25 was suggested by BMJ. Reduction of more than 5 percent of weight was suggested in obese diabetic women by TUA. Caring for constipation is mentioned for life modification by ACP and BMJ but no by TUA. At least four weeks of pharmacological treatment was mentioned in BMJ, but not clearly mentioned in ACP and TUA.
In this timely evaluation, variation exists between TUA and others in the CPGs for female incontinence. Several points are suggested to be revised in Taiwanese CPG by TUA. It is warranted to confirm these findings by further investigation.