European Association of Urology guidelines on assessment and nonsurgical management of urinary incontinence | Actas Urológicas Españolas (English Edition)

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This paper focuses on assessment, diagnosis, and conservative and drug therapy, but it excludes surgical management, which will be covered in a separate publication. The guidance is written by urologists for urologists, and it aims to provide clear practical guidance on the clinical care of people with urinary incontinence (UI). Care of people with neurologic UI is covered by other EAU guidelines.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The guidance does not encompass background topics such as causation, epidemiology, and psychology. Nor does it review evidence on the prevention of UI or the management of urinary fistula, but these issues will be fully addressed in future iterations. Our aim was to provide (1) a clear algorithm to guide care for people presenting with UI to use as a basis for thinking through patient management and planning and designing clinical services, (2) a concise structured referenced summary of current evidence on clinical topics, and (3) clear recommendations on what to do or not to do in most clinical circumstances. If possible, these are evidence based, but for practice areas for which there is little or no high-level evidence, we provide an expert view from panel consensus.The guidance focuses on uncomplicated patients but recognises that many patients have relevant comorbidity that affects the available treatment options and management decisions.MethodologyThe guidance was formulated using standard evidence based methodology. Every topic was defined as a precise clinical question, expressed in Population, Intervention, Comparator, Outcome (PICO) format<a class="elsevierStyleCrossRef" href="#bib0010">2</a> that formed the basis of the individual literature search strategies. Several high-quality systematic reviews, evidence-based guidelines, and some extensive narrative reviews have been produced recently using systematic PICO-based searches.Given the size of the task and our limited resources, we used the summarised evidence and identified literature from these as our source of evidence up to the cut-off date. We then performed, for each PICO, our own tailor-made searches from the cut-off date of the most recent review to our own cut-off date of July 2010. We searched Medline, Embase and the Cochrane Library and considered only English-language articles. We identified 3243 abstracts that were independently assessed by two panel members who selected 403 relevant studies.Each PICO was assigned to a panel member, who extracted the evidence from each selected full-text paper for incorporation into a dedicated database. Further discussion on each topic led to the development of summary statements that aimed to synthesise relevant clinical messages using levels of evidence (LEs) standardised by the EAU and led to phrasing of action-based recommendations, graded according to EAU standards (see full-text guidelines in the methodological section). These make it clear what the clinician should or should not do in clinical practice.This guidance is based on the best evidence available to the expert panel at the time of writing, but adherence does not guarantee best outcomes for individual patients. The need for clinical expertise when making treatment decisions for individual patients is paramount, taking into account the patient's personal values, preferences, and specific circumstances.Assessment and diagnosisFor all diagnostic techniques, three questions need to be answered: (1) What is the technical accuracy of the test in terms of reproducibility and reliability? (2) What is its diagnostic accuracy compared to a standard? (3) What is its prognostic value?History and physical examinationTaking a clinical history and performing a relevant thorough physical examination are fundamental to clinical care. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the important features of history taking and physical examination for the assessment of UI.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Patient questionnairesThere is no evidence that questionnaires or patient-reported outcome measures (PROMs) for assessment of adults with UI influence outcome (LE: 4). Symptom scores, symptom questionnaires, PROMs, or health-related quality-of-life measures are widely used to record symptoms and assess treatment benefit. The methodology for questionnaire development was reviewed by the 4th International Consultation on Incontinence in 2008.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Although many studies have investigated the validity and reliability of questionnaires and PROMs, most have taken place in adults without UI.Voiding diariesVoiding diaries of 3–7d duration are reliable for quantifying mean voided volume and daytime and nighttime frequency (LE: 2b). The choice of diary duration appears to be based on the possible behavioural therapeutic effect of keeping a diary rather than on validity or reliability<a class="elsevierStyleCrossRefs" href="#bib0020">4–7</a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Urinalysis and urinary tract infectionThere is no evidence that urinary tract infection (UTI) causes UI or that treating UTI cures UI (LE: 4), but the presence of symptomatic UTI does worsen the symptoms of UI (LE: 3).<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In contrast with symptomatic UTI, asymptomatic bacteriuria appears to have little influence on UI. Elderly nursing home patients with established UI do not benefit from the treatment of asymptomatic bacteriuria (LE: 2).<a class="elsevierStyleCrossRef" href="#bib0045">9</a> For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Postvoiding residualUltrasonography (US) provides an accurate estimate of postvoiding residual (PVR) (LE: 1b). Although most studies investigating PVR have not included patients with UI, there is a consensus that US is the best method of measuring PVR.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Lower urinary tract dysfunction is associated with a higher risk of PVR compared with controls (LE: 2). High PVR is not a risk factor for poor outcome in the management of UI (LE: 2).<a class="elsevierStyleCrossRef" href="#bib0060">12</a> There is a lack of evidence to support the routine measurement of PVR in patients with UI. For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>UrodynamicsThere is a consensus that urodynamic tests should aim to reproduce symptoms, and if not, the findings are inevitably inconclusive. There is also a consensus that attention to technical and methodological detail during urodynamic testing may increase the technical and diagnostic accuracy of urodynamics in recording usual bladder behaviour. In clinical practice, urodynamic testing (cystometry) may help to provide or confirm diagnosis, predict treatment outcome, or facilitate discussion during a consultation.Technical accuracyMost urodynamic parameters show a high random immediate- and short-term test–retest variability of up to ±15% in the same patient (LE: 2).<a class="elsevierStyleCrossRefs" href="#bib0065">13–15</a> Test–retest variability creates an overlap between so-called normal and abnormal populations, which may make it more difficult to categorise urodynamic findings in a particular individual (LE: 2). Different techniques of measuring urethral function may perform reliably from one test to another but do not reliably correlate with other tests<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> or to the severity of UI (LE: 3). Measurement of leak point pressures has not been standardised, and evidence on whether there is correlation with UI severity or other measures of urethral function is conflicting.<a class="elsevierStyleCrossRefs" href="#bib0090">18–21</a>Diagnostic accuracyThere may be inconsistency between history and urodynamic results (LE: 3). There is good inter- and intrarater reliability of video urodynamics for the severity and type of stress UI (SUI).<a class="elsevierStyleCrossRef" href="#bib0110">22</a> However, the diagnostic accuracy of urodynamics is questionable, with widely variable sensitivity and specificity for the symptom diagnosis of UI.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Prognostic valuePreliminary urodynamics do not affect the outcome of conservative therapy for UI (LE: 1a). A recent Cochrane review found that patients who underwent urodynamic were more likely to be prescribed drug therapy. Urodynamic findings may change clinical decision making, but there was insufficient evidence to show whether this influenced clinical outcomes.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>Success or failure of surgery for stress urinary incontinenceThere is limited evidence that preliminary urodynamic testing predicts surgical outcomes in adults with UI (LE: 3). Up until July 2010 there were no randomised controlled trials (RCTs) addressing whether urodynamics influence outcome of surgery for female UI. Post hoc analysis of one trial failed to confirm a predictive value for urodynamics, although the success rate for women with urodynamic SUI exceeded that for those without.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> There is conflicting low-level evidence that urethral function tests predict failure of surgery for SUI in women<a class="elsevierStyleCrossRefs" href="#bib0125">25–27</a> (LE: 3). There is consistent low-level evidence that both the symptom of urgency and the urodynamic finding of detrusor overactivity are predictive of failure of SUI surgery in women,<a class="elsevierStyleCrossRefs" href="#bib0125">25,28,29</a> although the clinical usefulness remains doubtful (LE: 3).No RCTs have investigated prediction by urodynamics of complications of surgery for SUI in women, but post hoc analysis showed that low preoperative maximum flow rate, opening pressure, and closing pressure are not consistently associated with postoperative voiding difficulty.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> Preoperative urodynamics do not predict postoperative urgency syndrome.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> There is no evidence to determine whether preliminary urodynamics predict treatment outcomes in male UI (LE: 4).<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows recommendations for urodynamic assessment.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Pad testingA pad test can diagnose UI accurately, is reproducible, and correlates with symptoms<a class="elsevierStyleCrossRefs" href="#bib0155">31,32</a> (LE: 1b). Pad tests can be used to indicate treatment outcome<a class="elsevierStyleCrossRef" href="#bib0165">33</a> (LE: 1b). There is variation in the duration of the test and the physical activity undertaken during the test. A pad weight gain >1g in a 1-h test is a threshold for the diagnosis of UI<a class="elsevierStyleCrossRef" href="#bib0170">34</a> (LE: 2b). Patient adherence to home pad-testing protocols is poor<a class="elsevierStyleCrossRef" href="#bib0175">35</a> (LE: 1b). Home-based pad tests >24h provide no additional benefit over shorter tests<a class="elsevierStyleCrossRef" href="#bib0180">36</a> (LE: 2b). For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>ImagingImaging improves understanding of the anatomic and functional abnormalities that may cause UI, but its contribution to clinical care is less clear. No imaging test has been shown to predict the outcome of treatment for UI. Ultrasonography or magnetic resonance imaging (MRI) can reliably measure bladder neck and urethral mobility, although there is no evidence of clinical benefit in UI<a class="elsevierStyleCrossRef" href="#bib0185">37</a> (LE: 2b). Imaging of the pelvic floor can identify levator ani detachment and hiatus dimensions, although there is little evidence of clinical benefit (LE: 2b). MRI can assess pelvic organ prolapse, anorectal function, and the integrity of the pelvic floor support structures,<a class="elsevierStyleCrossRef" href="#bib0190">38</a> but interpretation varies widely.<a class="elsevierStyleCrossRef" href="#bib0195">39</a> Ultrasonography can image midurethral slings, although more research is needed regarding the relationship between sling position and surgical outcome (LE: 2b). Imaging for determination of the effect of midurethral sling insertion for SUI has been assessed. The position of midurethral slings with respect to the pubis is associated with the cure of UI.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> For recommendation, see <a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>.<elsevierMultimedia ident="tbl0035"></elsevierMultimedia>Conservative treatmentSimple clinical interventionsTreatment of comorbidity and adjustment of medicationOne study suggested no correlation between early intensive treatment of type 1 diabetes mellitus and the prevalence of UI in later life versus “conventional treatment”.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> Improved diabetic control neither resolves nor improves UI (LE: 3). There is weak evidence that medication is associated with new, or worsening UI (LE: 3). a-Blockers used to treat hypertension in women may cause or exacerbate UI, and stopping them may relieve UI (LE: 3).<a class="elsevierStyleCrossRef" href="#bib0210">42</a> However, diuretics given to elderly patients do not cause or worsen UI.<a class="elsevierStyleCrossRef" href="#bib0215">43</a> Central nervous system agents may cause UI as a side effect (LE: 3).<a class="elsevierStyleCrossRef" href="#bib0220">44</a>Systemic oestrogen replacement in previously continent women approximately doubles the prevalence of UI at 12 mo compared with placebo (LE: 1b).<a class="elsevierStyleCrossRef" href="#bib0225">45</a> Women with preexisting UI who use systemic oestrogen replacement are 30% more likely to experience worsening UI compared with placebo (LE: 1a). For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0040">Table 8</a>.<elsevierMultimedia ident="tbl0040"></elsevierMultimedia>ConstipationThere is a consistent association between a history of constipation and the development of UI and pelvic organ prolapse (LE: 3).<a class="elsevierStyleCrossRefs" href="#bib0230">46,47</a> Multimodal behavioural therapy improves constipation and UI in elderly patients (LE: 1b).<a class="elsevierStyleCrossRef" href="#bib0240">48</a> There is no evidence that treatment of constipation improves UI, but expert opinion strongly supports treating constipation in these patients (LE: 4). For recommendation, see <a class="elsevierStyleCrossRef" href="#tbl0045">Table 9</a>.<elsevierMultimedia ident="tbl0045"></elsevierMultimedia>ContainmentThere were two consensus statements in the 4th International Consultation on Incontinence<a class="elsevierStyleCrossRef" href="#bib0245">49</a> and one RCT comparing conservative treatment with urinary pads.<a class="elsevierStyleCrossRef" href="#bib0250">50</a> There have been Cochrane reviews of devices<a class="elsevierStyleCrossRef" href="#bib0255">51</a> and pads.<a class="elsevierStyleCrossRef" href="#bib0260">52</a> There is an RCT comparing condom catheters with indwelling urinary catheters.<a class="elsevierStyleCrossRef" href="#bib0265">53</a> See <a class="elsevierStyleCrossRef" href="#tbl0050">Table 10</a> for evidence and <a class="elsevierStyleCrossRef" href="#tbl0055">Table 11</a> for recommendations on containment.<elsevierMultimedia ident="tbl0050"></elsevierMultimedia><elsevierMultimedia ident="tbl0055"></elsevierMultimedia>Lifestyle interventionsCaffeine intakeCaffeine reduction was shown to improve urinary frequency but not UI<a class="elsevierStyleCrossRefs" href="#bib0270">54–56</a> (LE: 2).Physical exerciseThe association between exercise and UI is unclear. Female athletes may experience UI during intense physical activity but not during common activities (LE: 3).<a class="elsevierStyleCrossRefs" href="#bib0285">57–59</a> However, strenuous physical activity does not predispose women to UI in later life (LE: 3).<a class="elsevierStyleCrossRef" href="#bib0300">60</a> Although moderate exercise is associated with lower rates of UI in middle-age or older women, there is no evidence that starting moderate exercise improves established UI in women (LE: 2b).<a class="elsevierStyleCrossRefs" href="#bib0305">61,62</a>Fluid intakeThere is conflicting evidence on whether fluid modification changes the symptoms of UI and quality of life (LE: 2).All available studies were in women.<a class="elsevierStyleCrossRef" href="#bib0280">56</a> A more recent RCT<a class="elsevierStyleCrossRef" href="#bib0315">63</a> showed that a 25% reduction in fluid intake improved symptoms in patients with overactive bladder but not UI.Obesity and weight lossObesity is a risk factor for UI in women (LE: 1b).<a class="elsevierStyleCrossRef" href="#bib0320">64</a> Two systematic reviews concluded that supervised weight loss (>5%) improves UI symptoms (LE: 1b).<a class="elsevierStyleCrossRefs" href="#bib0325">65,66</a>SmokingThere is no consistent evidence that smokers are more likely to have UI (LE: 3), but they may have a higher prevalence of severe UI (LE: 3). There is no evidence that smoking cessation improves UI symptoms (LE: 4).<a class="elsevierStyleCrossRef" href="#bib0330">66</a> For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0060">Table 12</a>.<elsevierMultimedia ident="tbl0060"></elsevierMultimedia>Behavioural and physical therapiesThere is limited evidence that supervised bladder training is better than no treatment in women with urgency UI (UUI) and mixed UI (MUI) (LE: 1b). However, the effectiveness of bladder training diminishes after treatment cessation (LE: 2). There are no adverse events. Bladder training has been compared with other treatments for UI.<a class="elsevierStyleCrossRef" href="#bib0330">66</a> There is inconsistent evidence to show whether bladder training is better than drug therapy (LE: 2). The combination of bladder training with antimuscarinic drugs does not result in greater improvement of UI (LE: 2). Bladder training is better than pessary alone (LE: 1b). Timed voiding reduces leakage episodes in cognitively impaired men and women (LE: 1b).<a class="elsevierStyleCrossRef" href="#bib0335">67</a>Pelvic floor muscle therapy in womenIt has been shown that pelvic floor muscle therapy (PFMT) cures or improves UI more often than no treatment.<a class="elsevierStyleCrossRef" href="#bib0340">68</a> One recent RCT found that PFMT in a group setting can be as effective as individual treatment.<a class="elsevierStyleCrossRef" href="#bib0345">69</a> One RCT with a 15-yr follow-up showed that long-term adherence to PFMT schedules was poor (see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>).<elsevierMultimedia ident="tbl0065"></elsevierMultimedia>PFMT has been compared with several alternative therapies, alone or in combination, in a mixed treatment comparison.<a class="elsevierStyleCrossRef" href="#bib0330">66</a> This supported the general principle that greater efficacy was achieved by adding together different modalities of treatment and increasing intensity (see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>).PFMT for UI in the postpartum period was shown to increase the rate of cure after 12mo.<a class="elsevierStyleCrossRef" href="#bib0350">70</a>Pelvic floor muscle therapy in men with stress urinary incontinence following radical prostatectomyPelvic floor muscle therapy was shown to hasten recovery of continence in men with SUI after radical prostatectomy but does not improve overall continence rates at 12mo<a class="elsevierStyleCrossRefs" href="#bib0285">57,71,72</a> (see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>).Preventive value of pelvic floor muscle therapyIt has been shown that PFMT reduces the risk of incontinence in late pregnancy and up to 6mo postpartum<a class="elsevierStyleCrossRef" href="#bib0350">70</a> and that preoperative PFMT speeds recovery of continence in men undergoing radical prostatectomy.<a class="elsevierStyleCrossRef" href="#bib0365">73</a>Electrical stimulation (surface electrodes)Most evidence on electrical stimulation involves only women and is inconsistent about whether alone it can improve UI (LE: 2). Three systematic reviews were found<a class="elsevierStyleCrossRefs" href="#bib0330">66,74,75</a> that included studies of low quality with a lack of consistency in the parameters used for electrical stimulation and outcome measures. It was not possible to compare or pool data from most of these studies.Magnetic stimulationThere is no consistent evidence for the efficacy of magnetic stimulation for the cure or improvement of UI (LE: 2a), although there are no reports of adverse events (LE: 1b). Eight RCTs were found, but they were mostly of poor quality. The techniques of electromagnetic stimulation were poorly standardised and involved different devices, modes of delivery, and stimulation parameters.<a class="elsevierStyleCrossRefs" href="#bib0380">76,77</a> Blinding was difficult to achieve, which resulted in a high risk of bias in some trials. There was a lack of evidence for effectiveness in men with UI.Posterior (percutaneous) tibial nerve stimulationCompared with sham treatment, percutaneous tibial nerve stimulation (PTNS) was shown to improve but not cure UUI in some women who have not benefited from antimuscarinic medication (LE: 1b).<a class="elsevierStyleCrossRefs" href="#bib0390">78,79</a> PTNS is no more effective than tolterodine for the improvement of UUI in women (LE: 2b).<a class="elsevierStyleCrossRef" href="#bib0395">79</a> No serious adverse events have been reported (LE: 3). There are insufficient data to determine the effectiveness of PTNS in men (LE: 4).For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0070">Table 14</a>.<elsevierMultimedia ident="tbl0070"></elsevierMultimedia>Drug treatmentAntimuscarinic drugsAntimuscarinic drugs are an early treatment option for adults with UUI, as indicated in the care pathway (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Immediate-release (IR), extended-release (ER), long-acting, and transdermal formulations are available. More than 50% of patients stop antimuscarinic drugs within the first 3mo because of lack of benefit, adverse effects, and cost (LE: 2). For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0075">Table 15</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0075"></elsevierMultimedia>Comparisons with placeboAll antimuscarinic drugs available as IR or transdermal preparations improved UUI (LE: 1a).<a class="elsevierStyleCrossRefs" href="#bib0400">80–83</a> All available drugs except trospium IR demonstrated higher rates of cure of UUI compared with placebo (LE: 1a). Oxybutynin topical gel was effective for cure and improvement of UUI.<a class="elsevierStyleCrossRef" href="#bib0420">84</a> Compared with placebo, frequency of dry mouth was higher with all IR drugs and similar with transdermal oxybutynin (LE: 1a). Extended-release formulations of antimuscarinic drugs are effective for improvement and cure of UUI (LE: 1b),<a class="elsevierStyleCrossRefs" href="#bib0410">82,85–90</a> but all show higher rates of dry mouth compared with placebo (LE: 1b).One drug against anotherThere is no consistent evidence that one antimuscarinic drug is superior to another for cure or improvement of UUI or improvement in quality of life (LE: 1a). There is weak evidence that oxybutynin ER is more effective than tolterodine ER for the cure of UI (LE: 1b).<a class="elsevierStyleCrossRefs" href="#bib0405">81,91</a> There is some evidence that fesoterodine is superior to tolterodine ER for cure and improvement of UI (LE: 1b).<a class="elsevierStyleCrossRefs" href="#bib0425">85,86,92</a> ER and long-acting antimuscarinic drugs are generally associated with lower rates of dry mouth than IR preparations, although discontinuation rates are similar (LE: 1b). Transdermal oxybutynin is associated with lower rates of dry mouth than oral drugs, but it has a high rate of withdrawal due to skin reaction (LE: 1b).Drug versus nondrug treatmentEvidence comparing nondrug and drug treatment was summarised in four high-quality systematic reviews<a class="elsevierStyleCrossRefs" href="#bib0375">75,82,91,93</a> of trials of low or moderate quality. There is no consistent evidence to show superiority of drug therapy over behavioural therapy (LE: 1b). However, the addition of antimuscarinic drugs to primary behavioural therapy may be beneficial (LE: 2). Antimuscarinic drug treatment has a higher rate of adverse effects than behavioural therapy (LE: 1a).Drugs in elderly people and those with cognitive impairmentElderly people have been underrepresented in RCTs of antimuscarinic agents, despite having a higher prevalence of UUI. In three systematic reviews of antimuscarinic agents in elderly patients,<a class="elsevierStyleCrossRefs" href="#bib0455">91,94,95</a> there was conflicting evidence of the effect of oxybutynin on cognitive function; oxybutynin IR may worsen cognitive function (LE: 2), but oxybutynin ER does not worsen cognitive impairment in elderly women (LE: 1b). The effectiveness and risk of adverse events (including cognitive dysfunction) of solifenacin, tolterodine, and darifenacin do not differ with patient age (LE: 1b). When using antimuscarinic drugs in patients at risk of worsening cognitive function, it may be appropriate to monitor changes during initiation and continuation of treatment.DuloxetineDuloxetine has been investigated for relief of SUI in adults. It may be offered to both women and men with SUI for temporary improvement or when more effective options such as surgery cannot be used (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).There is evidence that duloxetine is beneficial at a typical dose of 80mg daily in women<a class="elsevierStyleCrossRefs" href="#bib0375">75,96</a> and men<a class="elsevierStyleCrossRef" href="#bib0215">43</a> with SUI or MUI. Duloxetine does not cure but does improve UI in women (LE: 1b) with no clear difference in efficacy between SUI and MUI. There is no evidence that duloxetine improves quality of life. There is no evidence that duloxetine is better than PFMT in women. There is weak evidence that duloxetine may be a beneficial adjunct to PFMT in men with post-prostatectomy incontinence (LE: 2). All studies showed high withdrawal rates for duloxetine, principally due to lack of benefit and nausea (LE: 1b). For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0080">Table 16</a>.<elsevierMultimedia ident="tbl0080"></elsevierMultimedia>Intravaginal oestrogenIntravaginal oestrogen improves vaginal and urinary symptoms in postmenopausal women irrespective of the presence of visible mucosal atrophy. It is a useful early option for women with all types of UI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There is consistent evidence that intravaginal oestrogen can cure and improve UI in postmenopausal women<a class="elsevierStyleCrossRef" href="#bib0225">45</a> (LE: 1a). For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0085">Table 17</a>.<elsevierMultimedia ident="tbl0085"></elsevierMultimedia>DesmopressinDesmopressin has been used effectively for the treatment of enuresis, principally in children and young adults. It is an option for women who require short-lived situational relief from episodes of UI (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).The risk of UI in women is reduced within 4h of taking desmopressin but not after 4h (LE: 1b).<a class="elsevierStyleCrossRef" href="#bib0485">97</a> Continuous desmopressin does not improve or cure UI (LE: 1).<a class="elsevierStyleCrossRef" href="#bib0490">98</a> For recommendations, see <a class="elsevierStyleCrossRef" href="#tbl0090">Table 18</a>.<elsevierMultimedia ident="tbl0090"></elsevierMultimedia>ConclusionsUrinary incontinence is a common symptom that people present to urology clinicians. We have presented a summary of the current evidence that will help clinicians assess, diagnose, and select the most appropriate conservative treatment for patients who come under their care (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). We have used the LEs found by our review of the literature together with the expert opinion of a panel of urologists to weight appropriately the strength of practice recommendations contained in the guideline. We hope this pragmatic approach will be useful for clinicians and patients in finding the best way for each individual to improve his or her UI and alleviate the distress that it causes.The present text represents a summary of the work. For more detailed information and a full list of references, access the full-text version freely available on the EAU Website at <a href="http://www.uroweb.org/">www.uroweb.org</a> (ISBN 978-90-79754-83-0). We believe our methodology provides a robust and sustainable way to produce authoritative, generalisable guidance that can be readily revised. In line with the policy of the EAU guidelines board, the guidelines on UI will be updated annually including the latest published evidence.Author contributionsMalcolm G. Lucas had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Study concept and design: Lucas.</li><li class="elsevierStyleListItem" id="lsti0010">2.Acquisition of data: Lucas, Bosch, Cruz, Pickard, de Ridder, Tubaro, Neisius, Turner, Madden, Nambiar.</li><li class="elsevierStyleListItem" id="lsti0015">3.Analysis and interpretation of data: Lucas, Bosch, Cruz, Pickard, de Ridder, Tubaro, Neisius, Turner, Madden, Nambiar.</li><li class="elsevierStyleListItem" id="lsti0020">4.Drafting of the manuscript: Lucas, Bosch, Cruz, Pickard, de Ridder, Tubaro, Neisius, Turner.</li><li class="elsevierStyleListItem" id="lsti0025">5.Critical revision of the manuscript for important intellectual content: Lucas, Bosch, Cruz, Pickard, de Ridder, Tubaro, Neisius, Turner, Burkhard.</li><li class="elsevierStyleListItem" id="lsti0030">6.Statistical analysis: None.</li><li class="elsevierStyleListItem" id="lsti0035">7.Obtaining funding: None.</li><li class="elsevierStyleListItem" id="lsti0040">8.Administrative, technical, or material support: EAU Guidelines Office.</li><li class="elsevierStyleListItem" id="lsti0045">9.Supervision: Lucas.</li><li class="elsevierStyleListItem" id="lsti0050">10.Other (specify): None.</li></ul>FundingNone.Conflicts of interestMalcolm G. Lucas certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following:Lucas receives fellowships and travel grants from GSK. Bosch participates in trials for Celon-Olympus and Astellas and receives research grants from Ferring and GSK. Cruz is a company consultant for Allergan, Recordati, and Astellas; receives company speaker honoraria from Allergan, Recordati, Astellas, Pfizer, and Kyorin; and participates in trials for Allergan and Pfizer. Pikard receives royalties from Mediplus Limited (to hospital). Neisius is company consultant and receives speaker honoraria from Siemens Healthcare; receives speaker honoraria from Pfizer; and participates in trials for Bayer and Kendle. De Ridder is a company consultant for Astellas, American Medical Systems, Bard, Xention, Pfizer, and Allergan; receives company speaker honoraria from Astellas, Pfizer, American Medical Systems, Bard, and Metronic; participates in trials for Astellas, Pfizer, Allergan, Ipsen, American Medical Systems, and Xention; and receives fellowships and travel grants from Astellas, Allergan, and AMS and research grants from American Medical Systems, Gynecare, Astellas, Medtronic, and Pfizer. Tubaro is a company consultant for Allergan, GSK, Orion, Novartis, Pfizer, and Ferring; receives company speaker honoraria from Amgen, FSK, and Pfizer; participates in trials for AMS, Lilly, GSK, Sanofi, and Takeda-Millennium; and receives research grants from AMS. Turner is director/employee of the Cambridge Urology Clinic. Burkhard, Narbiar, and Madded have nothing to disclose." 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"titulo" => "One drug against another" ] 3 => array:2 [ "identificador" => "sec0190" "titulo" => "Drug versus nondrug treatment" ] 4 => array:2 [ "identificador" => "sec0195" "titulo" => "Drugs in elderly people and those with cognitive impairment" ] 5 => array:2 [ "identificador" => "sec0200" "titulo" => "Duloxetine" ] 6 => array:2 [ "identificador" => "sec0205" "titulo" => "Intravaginal oestrogen" ] 7 => array:2 [ "identificador" => "sec0210" "titulo" => "Desmopressin" ] ] ] 9 => array:2 [ "identificador" => "sec0215" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0220" "titulo" => "Author contributions" ] 11 => array:2 [ "identificador" => "sec0225" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0230" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-11-13" "fechaAceptado" => "2012-12-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec243212" "palabras" => array:5 [ 0 => "Urinary incontinence" 1 => "Practice-based guidelines" 2 => "Diagnosis" 3 => "Non-surgical treatment" 4 => "European Association of Urology guidelines" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec243211" "palabras" => array:5 [ 0 => "Incontinencia urinaria" 1 => "Guías clínicas basadas en la práctica" 2 => "Diagnóstico" 3 => "Tratamiento no quirúrgico" 4 => "Guía clínica de la Asociación Europea de Urología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ContextThe previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology. ObjectiveWe present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination. Evidence acquisitionEvidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. Evidence summaryThe full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice. ConclusionsThese new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ContextoLa anterior guía clínica de la Asociación Europea de Urología (EAU) sobre incontinencia urinaria comprendía un resumen de las secciones de la Consulta Internacional de 2009 sobre la incontinencia. Se tomó la decisión en 2010 de volver a escribir esta guía clínica basándose en una revisión sistemática independiente llevada a cabo por el panel de guías clínicas de la EAU, utilizando una metodología sostenible. ObjetivoPresentamos una versión resumida de la guía clínica completa sobre la evaluación, el diagnóstico y el tratamiento no quirúrgico de la incontinencia urinaria, con el objetivo de aumentar su difusión. Adquisición de la evidenciaLa valoración de la evidencia incluyó una revisión pragmática de las revisiones sistemáticas existentes y nuevas búsquedas bibliográficas independientes, basadas en cuestiones sobre población, intervención, comparador y resultados. La evaluación de los trabajos fue realizada por un panel internacional de expertos, quienes también colaboraron en una serie de debates de consenso, para desarrollar breves resúmenes de evidencia estructurada y recomendaciones basadas en la acción utilizando un sistema modificado de Oxford. Resumen de la evidenciaLa versión completa de la guía clínica está disponible online (http://www.uroweb.org/guidelines/online-guidelines/). La guía clínica incluye algoritmos que remiten de nuevo al lector a la evidencia de apoyo y son más inmediatamente utilizables en la práctica clínica diaria. ConclusionesEsta nueva guía clínica presenta un resumen actualizado de la evidencia disponible, junto con claros algoritmos clínicos y recomendaciones basadas en la acción fundamentadas en la mejor evidencia disponible. Cuando dicha evidencia no existe presentan un consenso de opiniones de expertos." ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Lucas MG, et al. Guía clínica de la Asociación Europea de Urología sobre la evaluación y el tratamiento no quirúrgico de la incontinencia urinaria. Actas Urol Esp. 2013;37:199–213." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "The translation of this article was carried out with the permission of the European Association of Urology." ] ] "multimedia" => array:20 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3604 "Ancho" => 2259 "Tamanyo" => 502970 ] ] "descripcion" => array:1 [ "en" => "Clinical algorithm for the assessment and non-surgical treatment of incontinence in women." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3509 "Ancho" => 2668 "Tamanyo" => 475056 ] ] "descripcion" => array:1 [ "en" => "Clinical algorithm for the assessment and non-surgical treatment of incontinence in men." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Take a history to include the following:• Type of incontinence (stress, urgency or mixed)• Timing and severity• Associated urinary symptoms• Obstetric and gynaecological history• Relevant comorbidities including cognitive impairment• Medication review \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do a physical examination to include:• Abdominal examination to detect abdominal or pelvic mass• Perineal examination• Digital, vaginal or rectal examination• Assess oestrogenisation status in women• Assess voluntary pelvic floor contraction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consider early referral for further assessment:• UI associated with pain• Visible (?) haematuria• Recurrent urinary tract infection• Previous pelvic surgery or radiotherapy• Constant leak suspicious of fistula• Voiding difficulty• Suspicion of neurological disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356422.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Given Grade A because, despite absence of evidence, expert opinion assigns absolute importance to these steps." ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for history taking and physical examination." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voiding diaries should be used to evaluate coexisting storage and voiding dysfunction in clinical practice and research. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diary duration should be between 3 and 7 days. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356414.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for voiding dairies." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do urinalysis as a part of the initial assessment of a patient with urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In a patient with urinary incontinence, treat a symptomatic urinary tract infection appropriately (see ‘EAU Guidelines on Urological Infections’<a class="elsevierStyleCrossRef" href="#bib0050">10</a>). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not treat asymptomatic bacteriuria in elderly patients to improve urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356415.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for urinalysis and urinary tract infection." ] ] 5 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-voiding residual should be measured by ultrasound. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measure post-voiding residual in patients with urinary incontinence who have voiding dysfunction. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measure post-voiding residual when assessing patients with complicated urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-voiding residual should be monitored in patients receiving treatments that may cause or worsen voiding dysfunction. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356426.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for post-voiding residual volume." ] ] 6 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinicians carrying out urodynamics in patients with urinary incontinence should:Ensure that the test replicates patient's symptomsInterpret results in context of the clinical problemCheck recordings for quality controlRemember there may be physiological variability within the same individual. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Advise patients that the results of urodynamics may be useful in discussing treatment options, although there is limited evidence that performing urodynamics will alter the outcome of treatment for urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not routinely carry out urodynamics when offering conservative treatment for urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perform urodynamics if the findings may change the choice of surgical treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perform urodynamics prior to surgery for urinary incontinence if there are either symptoms of overactive bladder, a history of previous surgery or a suspicion of voiding difficulty. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not routinely carry out urethral pressure profilometry. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356418.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for urodynamics." ] ] 7 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use a pad test when quantification of urinary incontinence is required. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use repeat pad test if objective treatment outcome measure is required. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356417.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for pad testing." ] ] 8 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not routinely carry out imaging of the upper or lower urinary tract as part of the assessment of uncomplicated SUI in women. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356420.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendation for imaging." ] ] 9 => array:7 [ "identificador" => "tbl0040" "etiqueta" => "Table 8" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Take a drug history from all patients with urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inform women with urinary incontinence that begins or worsens after starting systemic oestrogen replacement therapy that it may cause urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Review any new medication associated with the development or worsening of urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356419.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for simple clinical interventions." ] ] 10 => array:7 [ "identificador" => "tbl0045" "etiqueta" => "Table 9" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">For adults with UI, treat coexisting constipation. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356423.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendation for constipation." ] ] 11 => array:7 [ "identificador" => "tbl0050" "etiqueta" => "Table 10" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">LE: \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pads are not effective as a treatment for UI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1b \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Different pads have different advantages and disadvantages. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1b \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intermittent catheterisation carries a lower risk of urinary tract infection and bacteriuria than indwelling catheterisation. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1b \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Containment devices are better than no treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There is not enough evidence to conclude which containment device is best. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Condom catheters are better than indwelling catheters if no residual urine is present. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1b \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There is no evidence to compare mechanical devices with other forms of treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356411.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Evidence on containment." ] ] 12 => array:7 [ "identificador" => "tbl0055" "etiqueta" => "Table 11" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer pads when containment of urinary incontinence is needed. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adapt the choice of pad to the type and severity of urinary incontinence and the patient's needs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer catheterisation to manage urinary incontinence when no other treatments can be considered. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer condom catheters to men with urinary incontinence without significant residual urine. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer to teach intermittent catheterisation to manage UI associated with retention of urine. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not routinely offer intravaginal devices as treatment for incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not use penile clamps for control of UI in men. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356424.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for containment." ] ] 13 => array:7 [ "identificador" => "tbl0060" "etiqueta" => "Table 12" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer obese women suffering from any urinary incontinence weight reduction programmes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Advise adults with urinary incontinence that reducing caffeine intake may improve symptoms of urgency and frequency but not incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with abnormally high or abnormally low fluid intake should be advised to modify their fluid intake appropriately. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Counsel female athletes experiencing urinary incontinence with intense physical activity that it will not predispose to urinary incontinence in later life. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with urinary incontinence who smoke should be given smoking cessation advice in line with good medical practice although there is no definite effect on urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356410.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for lifestyle interventions." ] ] 14 => array:7 [ "identificador" => "tbl0065" "etiqueta" => "Table 13" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">LE \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT is better than no treatment for reducing incontinence episodes and improving quality of life in women with SUI, and MUI. There is no evidence that PFMT is better than no treatment in providing a cure. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher-intensity regimes, or the addition of biofeedback, confer greater benefit, but differences are not sustained long term. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A taught/supervised programme of PFMT is more effective than self-taught PFMT. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Group-based PFMT is as effective as treatment delivered individually. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Short-term benefits of intensive PFMT are not maintained at 15 years’ follow-up. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT compared with other conservative treatments</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT results in better reduction in leakage episodes than training using vaginal cones, but no difference in self-reported cure or improvement. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT results in fewer incontinence episodes than electrical stimulation. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT does not result in measurable improvement in quality of life. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT is better than bladder training for improvement of leakage and quality of life, in women with SUI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There is no consistent difference between PFMT and bladder training for women with UUI or MUI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT is as effective as duloxetine in women with SUI and has fewer side effects. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT is better tolerated than oxybutynin for UUI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT is better than alpha-agonists for women with SUI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT in childbearing women</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT commencing in early pregnancy reduces the risk of incontinence in late pregnancy, and up to 6 months post-partum. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT commencing in the early postpartum period improves UI in women for up to 12 months. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT in men</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Men undergoing some form of PFMT, before or after radical prostatectomy achieve continence more quickly than non-treated men. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There is conflicting evidence on whether the addition of electrical stimulation or biofeedback or supervised training increases the effectiveness of PFMT alone. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There is no evidence that pre-operative PFMT prevents UI following radical prostatectomy. As with post-operative PFMT, it appears to lead to earlier recovery of continence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356416.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Evidence on Pelvic Floor Muscle Therapy (PFMT) as monotherapy." ] ] 15 => array:7 [ "identificador" => "tbl0070" "etiqueta" => "Table 14" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PFMT, pelvic floor muscle training; PTNS, posterior tibial nerve stimulation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer supervised PFMT, lasting at least 3 months, as a first-line therapy to women with stress or mixed urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PFMT programmes should be as intensive as possible. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consider using biofeedback as an adjunct in women with stress urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer supervised PFMT to continent women in their first pregnancy to help prevent incontinence in the postnatal period. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer instruction on pelvic floor exercises to men undergoing radical prostatectomy to speed recovery of urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer bladder training as a first-line therapy to adults with urgency urinary incontinence or mixed urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer timed voiding to adults with urinary incontinence, who are cognitively impaired. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not offer electrical stimulation with surface electrodes (skin, vaginal, anal) alone for the treatment of urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not offer magnetic stimulation for the treatment of urinary incontinence or overactive bladder in adult women. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not offer PTNS to women or men who are seeking a cure for UUI. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer, if available, PTNS as an option for improvement of UUI in women, but not men, who have not benefited from antimuscarinic medication. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356421.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for behavioural and physical therapies." ] ] 16 => array:7 [ "identificador" => "tbl0075" "etiqueta" => "Table 15" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "IR, immediate release; ER, extended release." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer IR or ER formulations of antimuscarinic drugs as an initial treatment option for adults with urgency urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If IR formulations of antimuscarinic drugs are unsuccessful for adults with urgency urinary incontinence, offer ER or long acting drugs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consider using transdermal oxybutynin if oral antimuscarinic agents cannot be tolerated due to dry mouth. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer and encourage review of benefit within one month to patients started on antimuscarinic drugs for urgency urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inform elderly patients of the risk of new or worsened cognitive impairment and assess cognitive function in those deemed to be of higher risk. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid using oxybutynin IR in patients who are at risk of cognitive impairment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use antimuscarinic drugs with caution in patients with cognitive impairment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356412.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for antimuscarinic drugs." ] ] 17 => array:7 [ "identificador" => "tbl0080" "etiqueta" => "Table 16" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duloxetine should not be offered to women or men who are seeking a cure for their incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duloxetine can be offered to women who are seeking temporary improvement in incontinence symptoms. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duloxetine can be offered as an adjunct to PFMT for men with post-prostatectomy stress urinary incontinence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duloxetine should be initiated using dose titration because of high adverse effect rates. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356413.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for duloxetine." ] ] 18 => array:7 [ "identificador" => "tbl0085" "etiqueta" => "Table 17" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer postmenopausal women with urinary incontinence local oestrogen therapy, although the ideal duration of therapy and best delivery method are uncertain. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356409.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for oestrogen." ] ] 19 => array:7 [ "identificador" => "tbl0090" "etiqueta" => "Table 18" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">GR \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Offer desmopressin to patients requiring occasional situational short-term relief from urinary incontinence, inform them that this drug is not licensed for this indication. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not use desmopressin for long-term control of urinary incontinence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab356425.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for desmopressin." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:98 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU guidelines on neurogenic lower urinary tract dysfunction" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2009.04.028" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2009" "volumen" => "56" "paginaInicial" => "81" "paginaFinal" => "88" "link" => array:1 [ …1] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Higgins JPT, Green S (Eds.). Cochrane handbook for systematic reviews of interventions, v.5.1.0. 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Special article

European Association of Urology guidelines on assessment and nonsurgical management of urinary incontinence

Guía clínica de la Asociación Europea de Urología sobre la evaluación y el tratamiento no quirúrgico de la incontinencia urinaria

M.G. Lucasa,

Corresponding author

malcolm.lucas@wales.nhs.com

Corresponding author.

, R.J.L. Boschb, F.C. Burkhardc, F. Cruzd, T.B. Maddene, A.K. Nambiara, A. Neisiusf, D.J.M.K. de Ridderg, A. Tubaroh, W.H. Turneri, R.S. Pickardj

a Department of Urology, Morriston Hospital, Swansea, United Kingdom

b Department of Urology, UMC Utrecht, Utrecht, Holland, The Netherlands

c Department of Urology, University Hospital Bern, Berna, Switzerland

d Department of Urology, Hospital de São João and Faculty of Medicine of University of Porto, Oporto, Portugal

e The Royal Liverpool University Hospital, Liverpool, United Kingdom

f Department of Urology, Universitätsmedizin Mainz, Mainz, Germany

g Department of Urology, University Hospital Leuven, Lovaina, Belgium

h Department of Urology, Sant’ Andrea Hospital La Sapienza, Roma, Italy

i Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom

j Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom

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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical algorithm for the assessment and non-surgical treatment of incontinence in men&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present a shortened version of the 2012 guidelines from the European Association of Urology &#40;EAU&#41; Working Panel on Urinary Incontinence &#40;<a href="http://www.uroweb.org/guidelines/onlineguidelines/">www&#46;uroweb&#46;org&#47;guidelines&#47;onlineguidelines&#47;</a>&#41; to encourage further dissemination&#46; This paper focuses on assessment&#44; diagnosis&#44; and conservative and drug therapy&#44; but it excludes surgical management&#44; which will be covered in a separate publication&#46; The guidance is written by urologists for urologists&#44; and it aims to provide clear practical guidance on the clinical care of people with urinary incontinence &#40;UI&#41;&#46; Care of people with neurologic UI is covered by other EAU guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The guidance does not encompass background topics such as causation&#44; epidemiology&#44; and psychology&#46; Nor does it review evidence on the prevention of UI or the management of urinary fistula&#44; but these issues will be fully addressed in future iterations&#46; Our aim was to provide &#40;1&#41; a clear algorithm to guide care for people presenting with UI to use as a basis for thinking through patient management and planning and designing clinical services&#44; &#40;2&#41; a concise structured referenced summary of current evidence on clinical topics&#44; and &#40;3&#41; clear recommendations on what to do or not to do in most clinical circumstances&#46; If possible&#44; these are evidence based&#44; but for practice areas for which there is little or no high-level evidence&#44; we provide an expert view from panel consensus&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The guidance focuses on uncomplicated patients but recognises that many patients have relevant comorbidity that affects the available treatment options and management decisions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0015" class="elsevierStylePara elsevierViewall">The guidance was formulated using standard evidence based methodology&#46; Every topic was defined as a precise clinical question&#44; expressed in Population&#44; Intervention&#44; Comparator&#44; Outcome &#40;PICO&#41; format<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> that formed the basis of the individual literature search strategies&#46; Several high-quality systematic reviews&#44; evidence-based guidelines&#44; and some extensive narrative reviews have been produced recently using systematic PICO-based searches&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Given the size of the task and our limited resources&#44; we used the summarised evidence and identified literature from these as our source of evidence up to the cut-off date&#46; We then performed&#44; for each PICO&#44; our own tailor-made searches from the cut-off date of the most recent review to our own cut-off date of July 2010&#46; We searched Medline&#44; Embase and the Cochrane Library and considered only English-language articles&#46; We identified 3243 abstracts that were independently assessed by two panel members who selected 403 relevant studies&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Each PICO was assigned to a panel member&#44; who extracted the evidence from each selected full-text paper for incorporation into a dedicated database&#46; Further discussion on each topic led to the development of summary statements that aimed to synthesise relevant clinical messages using levels of evidence &#40;LEs&#41; standardised by the EAU and led to phrasing of action-based recommendations&#44; graded according to EAU standards &#40;see full-text guidelines in the methodological section&#41;&#46; These make it clear what the clinician should or should not do in clinical practice&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This guidance is based on the best evidence available to the expert panel at the time of writing&#44; but adherence does not guarantee best outcomes for individual patients&#46; The need for clinical expertise when making treatment decisions for individual patients is paramount&#44; taking into account the patient&#39;s personal values&#44; preferences&#44; and specific circumstances&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Assessment and diagnosis</span><p id="par0035" class="elsevierStylePara elsevierViewall">For all diagnostic techniques&#44; three questions need to be answered&#58; &#40;1&#41; What is the technical accuracy of the test in terms of reproducibility and reliability&#63; &#40;2&#41; What is its diagnostic accuracy compared to a standard&#63; &#40;3&#41; What is its prognostic value&#63;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">History and physical examination</span><p id="par0040" class="elsevierStylePara elsevierViewall">Taking a clinical history and performing a relevant thorough physical examination are fundamental to clinical care&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the important features of history taking and physical examination for the assessment of UI&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient questionnaires</span><p id="par0045" class="elsevierStylePara elsevierViewall">There is no evidence that questionnaires or patient-reported outcome measures &#40;PROMs&#41; for assessment of adults with UI influence outcome &#40;LE&#58; 4&#41;&#46; Symptom scores&#44; symptom questionnaires&#44; PROMs&#44; or health-related quality-of-life measures are widely used to record symptoms and assess treatment benefit&#46; The methodology for questionnaire development was reviewed by the 4th International Consultation on Incontinence in 2008&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although many studies have investigated the validity and reliability of questionnaires and PROMs&#44; most have taken place in adults without UI&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Voiding diaries</span><p id="par0050" class="elsevierStylePara elsevierViewall">Voiding diaries of 3&#8211;7<span class="elsevierStyleHsp" style=""></span>d duration are reliable for quantifying mean voided volume and daytime and nighttime frequency &#40;LE&#58; 2b&#41;&#46; The choice of diary duration appears to be based on the possible behavioural therapeutic effect of keeping a diary rather than on validity or reliability<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Urinalysis and urinary tract infection</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is no evidence that urinary tract infection &#40;UTI&#41; causes UI or that treating UTI cures UI &#40;LE&#58; 4&#41;&#44; but the presence of symptomatic UTI does worsen the symptoms of UI &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In contrast with symptomatic UTI&#44; asymptomatic bacteriuria appears to have little influence on UI&#46; Elderly nursing home patients with established UI do not benefit from the treatment of asymptomatic bacteriuria &#40;LE&#58; 2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Postvoiding residual</span><p id="par0060" class="elsevierStylePara elsevierViewall">Ultrasonography &#40;US&#41; provides an accurate estimate of postvoiding residual &#40;PVR&#41; &#40;LE&#58; 1b&#41;&#46; Although most studies investigating PVR have not included patients with UI&#44; there is a consensus that US is the best method of measuring PVR&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Lower urinary tract dysfunction is associated with a higher risk of PVR compared with controls &#40;LE&#58; 2&#41;&#46; High PVR is not a risk factor for poor outcome in the management of UI &#40;LE&#58; 2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> There is a lack of evidence to support the routine measurement of PVR in patients with UI&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Urodynamics</span><p id="par0065" class="elsevierStylePara elsevierViewall">There is a consensus that urodynamic tests should aim to reproduce symptoms&#44; and if not&#44; the findings are inevitably inconclusive&#46; There is also a consensus that attention to technical and methodological detail during urodynamic testing may increase the technical and diagnostic accuracy of urodynamics in recording usual bladder behaviour&#46; In clinical practice&#44; urodynamic testing &#40;cystometry&#41; may help to provide or confirm diagnosis&#44; predict treatment outcome&#44; or facilitate discussion during a consultation&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Technical accuracy</span><p id="par0070" class="elsevierStylePara elsevierViewall">Most urodynamic parameters show a high random immediate- and short-term test&#8211;retest variability of up to &#177;15&#37; in the same patient &#40;LE&#58; 2&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> Test&#8211;retest variability creates an overlap between so-called normal and abnormal populations&#44; which may make it more difficult to categorise urodynamic findings in a particular individual &#40;LE&#58; 2&#41;&#46; Different techniques of measuring urethral function may perform reliably from one test to another but do not reliably correlate with other tests<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> or to the severity of UI &#40;LE&#58; 3&#41;&#46; Measurement of leak point pressures has not been standardised&#44; and evidence on whether there is correlation with UI severity or other measures of urethral function is conflicting&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;21</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Diagnostic accuracy</span><p id="par0075" class="elsevierStylePara elsevierViewall">There may be inconsistency between history and urodynamic results &#40;LE&#58; 3&#41;&#46; There is good inter- and intrarater reliability of video urodynamics for the severity and type of stress UI &#40;SUI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> However&#44; the diagnostic accuracy of urodynamics is questionable&#44; with widely variable sensitivity and specificity for the symptom diagnosis of UI&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Prognostic value</span><p id="par0080" class="elsevierStylePara elsevierViewall">Preliminary urodynamics do not affect the outcome of conservative therapy for UI &#40;LE&#58; 1a&#41;&#46; A recent Cochrane review found that patients who underwent urodynamic were more likely to be prescribed drug therapy&#46; Urodynamic findings may change clinical decision making&#44; but there was insufficient evidence to show whether this influenced clinical outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Success or failure of surgery for stress urinary incontinence</span><p id="par0085" class="elsevierStylePara elsevierViewall">There is limited evidence that preliminary urodynamic testing predicts surgical outcomes in adults with UI &#40;LE&#58; 3&#41;&#46; Up until July 2010 there were no randomised controlled trials &#40;RCTs&#41; addressing whether urodynamics influence outcome of surgery for female UI&#46; Post hoc analysis of one trial failed to confirm a predictive value for urodynamics&#44; although the success rate for women with urodynamic SUI exceeded that for those without&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> There is conflicting low-level evidence that urethral function tests predict failure of surgery for SUI in women<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;27</span></a> &#40;LE&#58; 3&#41;&#46; There is consistent low-level evidence that both the symptom of urgency and the urodynamic finding of detrusor overactivity are predictive of failure of SUI surgery in women&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;28&#44;29</span></a> although the clinical usefulness remains doubtful &#40;LE&#58; 3&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">No RCTs have investigated prediction by urodynamics of complications of surgery for SUI in women&#44; but post hoc analysis showed that low preoperative maximum flow rate&#44; opening pressure&#44; and closing pressure are not consistently associated with postoperative voiding difficulty&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Preoperative urodynamics do not predict postoperative urgency syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> There is no evidence to determine whether preliminary urodynamics predict treatment outcomes in male UI &#40;LE&#58; 4&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows recommendations for urodynamic assessment&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Pad testing</span><p id="par0100" class="elsevierStylePara elsevierViewall">A pad test can diagnose UI accurately&#44; is reproducible&#44; and correlates with symptoms<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a> &#40;LE&#58; 1b&#41;&#46; Pad tests can be used to indicate treatment outcome<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> &#40;LE&#58; 1b&#41;&#46; There is variation in the duration of the test and the physical activity undertaken during the test&#46; A pad weight gain &#62;1<span class="elsevierStyleHsp" style=""></span>g in a 1-h test is a threshold for the diagnosis of UI<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> &#40;LE&#58; 2b&#41;&#46; Patient adherence to home pad-testing protocols is poor<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> &#40;LE&#58; 1b&#41;&#46; Home-based pad tests &#62;24<span class="elsevierStyleHsp" style=""></span>h provide no additional benefit over shorter tests<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> &#40;LE&#58; 2b&#41;&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Imaging</span><p id="par0105" class="elsevierStylePara elsevierViewall">Imaging improves understanding of the anatomic and functional abnormalities that may cause UI&#44; but its contribution to clinical care is less clear&#46; No imaging test has been shown to predict the outcome of treatment for UI&#46; Ultrasonography or magnetic resonance imaging &#40;MRI&#41; can reliably measure bladder neck and urethral mobility&#44; although there is no evidence of clinical benefit in UI<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> &#40;LE&#58; 2b&#41;&#46; Imaging of the pelvic floor can identify levator ani detachment and hiatus dimensions&#44; although there is little evidence of clinical benefit &#40;LE&#58; 2b&#41;&#46; MRI can assess pelvic organ prolapse&#44; anorectal function&#44; and the integrity of the pelvic floor support structures&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> but interpretation varies widely&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Ultrasonography can image midurethral slings&#44; although more research is needed regarding the relationship between sling position and surgical outcome &#40;LE&#58; 2b&#41;&#46; Imaging for determination of the effect of midurethral sling insertion for SUI has been assessed&#46; The position of midurethral slings with respect to the pubis is associated with the cure of UI&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> For recommendation&#44; see <a class="elsevierStyleCrossRef" href="#tbl0035">Table 7</a>&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conservative treatment</span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Simple clinical interventions</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Treatment of comorbidity and adjustment of medication</span><p id="par0110" class="elsevierStylePara elsevierViewall">One study suggested no correlation between early intensive treatment of type 1 diabetes mellitus and the prevalence of UI in later life versus &#8220;conventional treatment&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Improved diabetic control neither resolves nor improves UI &#40;LE&#58; 3&#41;&#46; There is weak evidence that medication is associated with new&#44; or worsening UI &#40;LE&#58; 3&#41;&#46; a-Blockers used to treat hypertension in women may cause or exacerbate UI&#44; and stopping them may relieve UI &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> However&#44; diuretics given to elderly patients do not cause or worsen UI&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> Central nervous system agents may cause UI as a side effect &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Systemic oestrogen replacement in previously continent women approximately doubles the prevalence of UI at 12 mo compared with placebo &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> Women with preexisting UI who use systemic oestrogen replacement are 30&#37; more likely to experience worsening UI compared with placebo &#40;LE&#58; 1a&#41;&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0040">Table 8</a>&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Constipation</span><p id="par0120" class="elsevierStylePara elsevierViewall">There is a consistent association between a history of constipation and the development of UI and pelvic organ prolapse &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46&#44;47</span></a> Multimodal behavioural therapy improves constipation and UI in elderly patients &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> There is no evidence that treatment of constipation improves UI&#44; but expert opinion strongly supports treating constipation in these patients &#40;LE&#58; 4&#41;&#46; For recommendation&#44; see <a class="elsevierStyleCrossRef" href="#tbl0045">Table 9</a>&#46;</p><elsevierMultimedia ident="tbl0045"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Containment</span><p id="par0125" class="elsevierStylePara elsevierViewall">There were two consensus statements in the 4th International Consultation on Incontinence<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> and one RCT comparing conservative treatment with urinary pads&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> There have been Cochrane reviews of devices<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> and pads&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> There is an RCT comparing condom catheters with indwelling urinary catheters&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a> See <a class="elsevierStyleCrossRef" href="#tbl0050">Table 10</a> for evidence and <a class="elsevierStyleCrossRef" href="#tbl0055">Table 11</a> for recommendations on containment&#46;</p><elsevierMultimedia ident="tbl0050"></elsevierMultimedia><elsevierMultimedia ident="tbl0055"></elsevierMultimedia></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Lifestyle interventions</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Caffeine intake</span><p id="par0130" class="elsevierStylePara elsevierViewall">Caffeine reduction was shown to improve urinary frequency but not UI<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">54&#8211;56</span></a> &#40;LE&#58; 2&#41;&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Physical exercise</span><p id="par0135" class="elsevierStylePara elsevierViewall">The association between exercise and UI is unclear&#46; Female athletes may experience UI during intense physical activity but not during common activities &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#8211;59</span></a> However&#44; strenuous physical activity does not predispose women to UI in later life &#40;LE&#58; 3&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> Although moderate exercise is associated with lower rates of UI in middle-age or older women&#44; there is no evidence that starting moderate exercise improves established UI in women &#40;LE&#58; 2b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">61&#44;62</span></a></p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Fluid intake</span><p id="par0140" class="elsevierStylePara elsevierViewall">There is conflicting evidence on whether fluid modification changes the symptoms of UI and quality of life &#40;LE&#58; 2&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">All available studies were in women&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> A more recent RCT<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a> showed that a 25&#37; reduction in fluid intake improved symptoms in patients with overactive bladder but not UI&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Obesity and weight loss</span><p id="par0150" class="elsevierStylePara elsevierViewall">Obesity is a risk factor for UI in women &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> Two systematic reviews concluded that supervised weight loss &#40;&#62;5&#37;&#41; improves UI symptoms &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">65&#44;66</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Smoking</span><p id="par0155" class="elsevierStylePara elsevierViewall">There is no consistent evidence that smokers are more likely to have UI &#40;LE&#58; 3&#41;&#44; but they may have a higher prevalence of severe UI &#40;LE&#58; 3&#41;&#46; There is no evidence that smoking cessation improves UI symptoms &#40;LE&#58; 4&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0060">Table 12</a>&#46;</p><elsevierMultimedia ident="tbl0060"></elsevierMultimedia></span></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Behavioural and physical therapies</span><p id="par0160" class="elsevierStylePara elsevierViewall">There is limited evidence that supervised bladder training is better than no treatment in women with urgency UI &#40;UUI&#41; and mixed UI &#40;MUI&#41; &#40;LE&#58; 1b&#41;&#46; However&#44; the effectiveness of bladder training diminishes after treatment cessation &#40;LE&#58; 2&#41;&#46; There are no adverse events&#46; Bladder training has been compared with other treatments for UI&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> There is inconsistent evidence to show whether bladder training is better than drug therapy &#40;LE&#58; 2&#41;&#46; The combination of bladder training with antimuscarinic drugs does not result in greater improvement of UI &#40;LE&#58; 2&#41;&#46; Bladder training is better than pessary alone &#40;LE&#58; 1b&#41;&#46; Timed voiding reduces leakage episodes in cognitively impaired men and women &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Pelvic floor muscle therapy in women</span><p id="par0165" class="elsevierStylePara elsevierViewall">It has been shown that pelvic floor muscle therapy &#40;PFMT&#41; cures or improves UI more often than no treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a> One recent RCT found that PFMT in a group setting can be as effective as individual treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> One RCT with a 15-yr follow-up showed that long-term adherence to PFMT schedules was poor &#40;see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0065"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">PFMT has been compared with several alternative therapies&#44; alone or in combination&#44; in a mixed treatment comparison&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> This supported the general principle that greater efficacy was achieved by adding together different modalities of treatment and increasing intensity &#40;see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">PFMT for UI in the postpartum period was shown to increase the rate of cure after 12<span class="elsevierStyleHsp" style=""></span>mo&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Pelvic floor muscle therapy in men with stress urinary incontinence following radical prostatectomy</span><p id="par0180" class="elsevierStylePara elsevierViewall">Pelvic floor muscle therapy was shown to hasten recovery of continence in men with SUI after radical prostatectomy but does not improve overall continence rates at 12<span class="elsevierStyleHsp" style=""></span>mo<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#44;71&#44;72</span></a> &#40;see <a class="elsevierStyleCrossRef" href="#tbl0065">Table 13</a>&#41;&#46;</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Preventive value of pelvic floor muscle therapy</span><p id="par0185" class="elsevierStylePara elsevierViewall">It has been shown that PFMT reduces the risk of incontinence in late pregnancy and up to 6<span class="elsevierStyleHsp" style=""></span>mo postpartum<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a> and that preoperative PFMT speeds recovery of continence in men undergoing radical prostatectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a></p></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Electrical stimulation &#40;surface electrodes&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Most evidence on electrical stimulation involves only women and is inconsistent about whether alone it can improve UI &#40;LE&#58; 2&#41;&#46; Three systematic reviews were found<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">66&#44;74&#44;75</span></a> that included studies of low quality with a lack of consistency in the parameters used for electrical stimulation and outcome measures&#46; It was not possible to compare or pool data from most of these studies&#46;</p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Magnetic stimulation</span><p id="par0195" class="elsevierStylePara elsevierViewall">There is no consistent evidence for the efficacy of magnetic stimulation for the cure or improvement of UI &#40;LE&#58; 2a&#41;&#44; although there are no reports of adverse events &#40;LE&#58; 1b&#41;&#46; Eight RCTs were found&#44; but they were mostly of poor quality&#46; The techniques of electromagnetic stimulation were poorly standardised and involved different devices&#44; modes of delivery&#44; and stimulation parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">76&#44;77</span></a> Blinding was difficult to achieve&#44; which resulted in a high risk of bias in some trials&#46; There was a lack of evidence for effectiveness in men with UI&#46;</p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Posterior &#40;percutaneous&#41; tibial nerve stimulation</span><p id="par0200" class="elsevierStylePara elsevierViewall">Compared with sham treatment&#44; percutaneous tibial nerve stimulation &#40;PTNS&#41; was shown to improve but not cure UUI in some women who have not benefited from antimuscarinic medication &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">78&#44;79</span></a> PTNS is no more effective than tolterodine for the improvement of UUI in women &#40;LE&#58; 2b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> No serious adverse events have been reported &#40;LE&#58; 3&#41;&#46; There are insufficient data to determine the effectiveness of PTNS in men &#40;LE&#58; 4&#41;&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0070">Table 14</a>&#46;</p><elsevierMultimedia ident="tbl0070"></elsevierMultimedia></span></span></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Drug treatment</span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Antimuscarinic drugs</span><p id="par0210" class="elsevierStylePara elsevierViewall">Antimuscarinic drugs are an early treatment option for adults with UUI&#44; as indicated in the care pathway &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Immediate-release &#40;IR&#41;&#44; extended-release &#40;ER&#41;&#44; long-acting&#44; and transdermal formulations are available&#46; More than 50&#37; of patients stop antimuscarinic drugs within the first 3<span class="elsevierStyleHsp" style=""></span>mo because of lack of benefit&#44; adverse effects&#44; and cost &#40;LE&#58; 2&#41;&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0075">Table 15</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0075"></elsevierMultimedia></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Comparisons with placebo</span><p id="par0215" class="elsevierStylePara elsevierViewall">All antimuscarinic drugs available as IR or transdermal preparations improved UUI &#40;LE&#58; 1a&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">80&#8211;83</span></a> All available drugs except trospium IR demonstrated higher rates of cure of UUI compared with placebo &#40;LE&#58; 1a&#41;&#46; Oxybutynin topical gel was effective for cure and improvement of UUI&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">84</span></a> Compared with placebo&#44; frequency of dry mouth was higher with all IR drugs and similar with transdermal oxybutynin &#40;LE&#58; 1a&#41;&#46; Extended-release formulations of antimuscarinic drugs are effective for improvement and cure of UUI &#40;LE&#58; 1b&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">82&#44;85&#8211;90</span></a> but all show higher rates of dry mouth compared with placebo &#40;LE&#58; 1b&#41;&#46;</p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">One drug against another</span><p id="par0220" class="elsevierStylePara elsevierViewall">There is no consistent evidence that one antimuscarinic drug is superior to another for cure or improvement of UUI or improvement in quality of life &#40;LE&#58; 1a&#41;&#46; There is weak evidence that oxybutynin ER is more effective than tolterodine ER for the cure of UI &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">81&#44;91</span></a> There is some evidence that fesoterodine is superior to tolterodine ER for cure and improvement of UI &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">85&#44;86&#44;92</span></a> ER and long-acting antimuscarinic drugs are generally associated with lower rates of dry mouth than IR preparations&#44; although discontinuation rates are similar &#40;LE&#58; 1b&#41;&#46; Transdermal oxybutynin is associated with lower rates of dry mouth than oral drugs&#44; but it has a high rate of withdrawal due to skin reaction &#40;LE&#58; 1b&#41;&#46;</p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Drug versus nondrug treatment</span><p id="par0225" class="elsevierStylePara elsevierViewall">Evidence comparing nondrug and drug treatment was summarised in four high-quality systematic reviews<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">75&#44;82&#44;91&#44;93</span></a> of trials of low or moderate quality&#46; There is no consistent evidence to show superiority of drug therapy over behavioural therapy &#40;LE&#58; 1b&#41;&#46; However&#44; the addition of antimuscarinic drugs to primary behavioural therapy may be beneficial &#40;LE&#58; 2&#41;&#46; Antimuscarinic drug treatment has a higher rate of adverse effects than behavioural therapy &#40;LE&#58; 1a&#41;&#46;</p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Drugs in elderly people and those with cognitive impairment</span><p id="par0230" class="elsevierStylePara elsevierViewall">Elderly people have been underrepresented in RCTs of antimuscarinic agents&#44; despite having a higher prevalence of UUI&#46; In three systematic reviews of antimuscarinic agents in elderly patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">91&#44;94&#44;95</span></a> there was conflicting evidence of the effect of oxybutynin on cognitive function&#59; oxybutynin IR may worsen cognitive function &#40;LE&#58; 2&#41;&#44; but oxybutynin ER does not worsen cognitive impairment in elderly women &#40;LE&#58; 1b&#41;&#46; The effectiveness and risk of adverse events &#40;including cognitive dysfunction&#41; of solifenacin&#44; tolterodine&#44; and darifenacin do not differ with patient age &#40;LE&#58; 1b&#41;&#46; When using antimuscarinic drugs in patients at risk of worsening cognitive function&#44; it may be appropriate to monitor changes during initiation and continuation of treatment&#46;</p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Duloxetine</span><p id="par0235" class="elsevierStylePara elsevierViewall">Duloxetine has been investigated for relief of SUI in adults&#46; It may be offered to both women and men with SUI for temporary improvement or when more effective options such as surgery cannot be used &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">There is evidence that duloxetine is beneficial at a typical dose of 80<span class="elsevierStyleHsp" style=""></span>mg daily in women<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">75&#44;96</span></a> and men<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> with SUI or MUI&#46; Duloxetine does not cure but does improve UI in women &#40;LE&#58; 1b&#41; with no clear difference in efficacy between SUI and MUI&#46; There is no evidence that duloxetine improves quality of life&#46; There is no evidence that duloxetine is better than PFMT in women&#46; There is weak evidence that duloxetine may be a beneficial adjunct to PFMT in men with post-prostatectomy incontinence &#40;LE&#58; 2&#41;&#46; All studies showed high withdrawal rates for duloxetine&#44; principally due to lack of benefit and nausea &#40;LE&#58; 1b&#41;&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0080">Table 16</a>&#46;</p><elsevierMultimedia ident="tbl0080"></elsevierMultimedia></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">Intravaginal oestrogen</span><p id="par0245" class="elsevierStylePara elsevierViewall">Intravaginal oestrogen improves vaginal and urinary symptoms in postmenopausal women irrespective of the presence of visible mucosal atrophy&#46; It is a useful early option for women with all types of UI &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There is consistent evidence that intravaginal oestrogen can cure and improve UI in postmenopausal women<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> &#40;LE&#58; 1a&#41;&#46; For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0085">Table 17</a>&#46;</p><elsevierMultimedia ident="tbl0085"></elsevierMultimedia></span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Desmopressin</span><p id="par0250" class="elsevierStylePara elsevierViewall">Desmopressin has been used effectively for the treatment of enuresis&#44; principally in children and young adults&#46; It is an option for women who require short-lived situational relief from episodes of UI &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The risk of UI in women is reduced within 4<span class="elsevierStyleHsp" style=""></span>h of taking desmopressin but not after 4<span class="elsevierStyleHsp" style=""></span>h &#40;LE&#58; 1b&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> Continuous desmopressin does not improve or cure UI &#40;LE&#58; 1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a> For recommendations&#44; see <a class="elsevierStyleCrossRef" href="#tbl0090">Table 18</a>&#46;</p><elsevierMultimedia ident="tbl0090"></elsevierMultimedia></span></span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Conclusions</span><p id="par0260" class="elsevierStylePara elsevierViewall">Urinary incontinence is a common symptom that people present to urology clinicians&#46; We have presented a summary of the current evidence that will help clinicians assess&#44; diagnose&#44; and select the most appropriate conservative treatment for patients who come under their care &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; We have used the LEs found by our review of the literature together with the expert opinion of a panel of urologists to weight appropriately the strength of practice recommendations contained in the guideline&#46; We hope this pragmatic approach will be useful for clinicians and patients in finding the best way for each individual to improve his or her UI and alleviate the distress that it causes&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">The present text represents a summary of the work&#46; For more detailed information and a full list of references&#44; access the full-text version freely available on the EAU Website at <a href="http://www.uroweb.org/">www&#46;uroweb&#46;org</a> &#40;ISBN 978-90-79754-83-0&#41;&#46; We believe our methodology provides a robust and sustainable way to produce authoritative&#44; generalisable guidance that can be readily revised&#46; In line with the policy of the EAU guidelines board&#44; the guidelines on UI will be updated annually including the latest published evidence&#46;</p></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Author contributions</span><p id="par0270" class="elsevierStylePara elsevierViewall">Malcolm G&#46; Lucas had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Study concept and design&#58; Lucas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Acquisition of data&#58; Lucas&#44; Bosch&#44; Cruz&#44; Pickard&#44; de Ridder&#44; Tubaro&#44; Neisius&#44; Turner&#44; Madden&#44; Nambiar&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Analysis and interpretation of data&#58; Lucas&#44; Bosch&#44; Cruz&#44; Pickard&#44; de Ridder&#44; Tubaro&#44; Neisius&#44; Turner&#44; Madden&#44; Nambiar&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Drafting of the manuscript&#58; Lucas&#44; Bosch&#44; Cruz&#44; Pickard&#44; de Ridder&#44; Tubaro&#44; Neisius&#44; Turner&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Critical revision of the manuscript for important intellectual content&#58; Lucas&#44; Bosch&#44; Cruz&#44; Pickard&#44; de Ridder&#44; Tubaro&#44; Neisius&#44; Turner&#44; Burkhard&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; None&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Obtaining funding&#58; None&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Administrative&#44; technical&#44; or material support&#58; EAU Guidelines Office&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Supervision&#58; Lucas&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0320" class="elsevierStylePara elsevierViewall">Other &#40;specify&#41;&#58; None&#46;</p></li></ul></p></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Funding</span><p id="par0325" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Conflicts of interest</span><p id="par0330" class="elsevierStylePara elsevierViewall">Malcolm G&#46; Lucas certifies that all conflicts of interest&#44; including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript &#40;e&#46;g&#46;&#44; employment&#47;affiliation&#44; grants or funding&#44; consultancies&#44; honoraria&#44; stock ownership or options&#44; expert testimony&#44; royalties&#44; or patents filed&#44; received&#44; or pending&#41;&#44; are the following&#58;</p><p id="par0335" class="elsevierStylePara elsevierViewall">Lucas receives fellowships and travel grants from GSK&#46; Bosch participates in trials for Celon-Olympus and Astellas and receives research grants from Ferring and GSK&#46; Cruz is a company consultant for Allergan&#44; Recordati&#44; and Astellas&#59; receives company speaker honoraria from Allergan&#44; Recordati&#44; Astellas&#44; Pfizer&#44; and Kyorin&#59; and participates in trials for Allergan and Pfizer&#46; Pikard receives royalties from Mediplus Limited &#40;to hospital&#41;&#46; Neisius is company consultant and receives speaker honoraria from Siemens Healthcare&#59; receives speaker honoraria from Pfizer&#59; and participates in trials for Bayer and Kendle&#46; De Ridder is a company consultant for Astellas&#44; American Medical Systems&#44; Bard&#44; Xention&#44; Pfizer&#44; and Allergan&#59; receives company speaker honoraria from Astellas&#44; Pfizer&#44; American Medical Systems&#44; Bard&#44; and Metronic&#59; participates in trials for Astellas&#44; Pfizer&#44; Allergan&#44; Ipsen&#44; American Medical Systems&#44; and Xention&#59; and receives fellowships and travel grants from Astellas&#44; Allergan&#44; and AMS and research grants from American Medical Systems&#44; Gynecare&#44; Astellas&#44; Medtronic&#44; and Pfizer&#46; Tubaro is a company consultant for Allergan&#44; GSK&#44; Orion&#44; Novartis&#44; Pfizer&#44; and Ferring&#59; receives company speaker honoraria from Amgen&#44; FSK&#44; and Pfizer&#59; participates in trials for AMS&#44; Lilly&#44; GSK&#44; Sanofi&#44; and Takeda-Millennium&#59; and receives research grants from AMS&#46; Turner is director&#47;employee of the Cambridge Urology Clinic&#46; Burkhard&#44; Narbiar&#44; and Madded have nothing to disclose&#46;</p></span></span>"
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            2 => "Diagn&#243;stico"
            3 => "Tratamiento no quir&#250;rgico"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Context</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The previous European Association of Urology &#40;EAU&#41; guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence&#46; A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel&#44; using a sustainable methodology&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present a short version of the full guidelines on assessment&#44; diagnosis&#44; and nonsurgical treatment of urinary incontinence&#44; with the aim of increasing their dissemination&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Evidence acquisition</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches&#44; based on Population&#44; Intervention&#44; Comparator&#44; Outcome questions&#46; Appraisal of papers was carried out by an international panel of experts&#44; who also collaborated on a series of consensus discussions&#44; to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Evidence summary</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The full version of the guidelines is available online &#40;<span class="elsevierStyleInterRef" id="intr0005" href="http://www.uroweb.org/guidelines/online-guidelines/">http&#58;&#47;&#47;www&#46;uroweb&#46;org&#47;guidelines&#47;online-guidelines&#47;</span>&#41;&#46; The guidelines include algorithms that refer the reader back to the supporting evidence&#44; and they are more immediately useable in daily clinical practice&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">These new guidelines present an up-to-date summary of the available evidence&#44; together with clear clinical algorithms and action-based recommendations based on the best available evidence&#46; Where such evidence does not exist&#44; they present a consensus of expert opinion&#46;</p>"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Contexto</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La anterior gu&#237;a cl&#237;nica de la Asociaci&#243;n Europea de Urolog&#237;a &#40;EAU&#41; sobre incontinencia urinaria comprend&#237;a un resumen de las secciones de la Consulta Internacional de 2009 sobre la incontinencia&#46; Se tom&#243; la decisi&#243;n en 2010 de volver a escribir esta gu&#237;a cl&#237;nica bas&#225;ndose en una revisi&#243;n sistem&#225;tica independiente llevada a cabo por el panel de gu&#237;as cl&#237;nicas de la EAU&#44; utilizando una metodolog&#237;a sostenible&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentamos una versi&#243;n resumida de la gu&#237;a cl&#237;nica completa sobre la evaluaci&#243;n&#44; el diagn&#243;stico y el tratamiento no quir&#250;rgico de la incontinencia urinaria&#44; con el objetivo de aumentar su difusi&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Adquisici&#243;n de la evidencia</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La valoraci&#243;n de la evidencia incluy&#243; una revisi&#243;n pragm&#225;tica de las revisiones sistem&#225;ticas existentes y nuevas b&#250;squedas bibliogr&#225;ficas independientes&#44; basadas en cuestiones sobre poblaci&#243;n&#44; intervenci&#243;n&#44; comparador y resultados&#46; La evaluaci&#243;n de los trabajos fue realizada por un panel internacional de expertos&#44; quienes tambi&#233;n colaboraron en una serie de debates de consenso&#44; para desarrollar breves res&#250;menes de evidencia estructurada y recomendaciones basadas en la acci&#243;n utilizando un sistema modificado de Oxford&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resumen de la evidencia</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n completa de la gu&#237;a cl&#237;nica est&#225; disponible online &#40;<span class="elsevierStyleInterRef" id="intr0010" href="http://www.uroweb.org/guidelines/online-guidelines/">http&#58;&#47;&#47;www&#46;uroweb&#46;org&#47;guidelines&#47;online-guidelines&#47;</span>&#41;&#46; La gu&#237;a cl&#237;nica incluye algoritmos que remiten de nuevo al lector a la evidencia de apoyo y son m&#225;s inmediatamente utilizables en la pr&#225;ctica cl&#237;nica diaria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Esta nueva gu&#237;a cl&#237;nica presenta un resumen actualizado de la evidencia disponible&#44; junto con claros algoritmos cl&#237;nicos y recomendaciones basadas en la acci&#243;n fundamentadas en la mejor evidencia disponible&#46; Cuando dicha evidencia no existe presentan un consenso de opiniones de expertos&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Lucas MG&#44; et al&#46; Gu&#237;a cl&#237;nica de la Asociaci&#243;n Europea de Urolog&#237;a sobre la evaluaci&#243;n y el tratamiento no quir&#250;rgico de la incontinencia urinaria&#46; Actas Urol Esp&#46; 2013&#59;37&#58;199&#8211;213&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Do a physical examination to include&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; Abdominal examination to detect abdominal or pelvic mass<span class="elsevierStyleHsp" style=""></span>&#8226; Perineal examination<span class="elsevierStyleHsp" style=""></span>&#8226; Digital&#44; vaginal or rectal examination<span class="elsevierStyleHsp" style=""></span>&#8226; Assess oestrogenisation status in women<span class="elsevierStyleHsp" style=""></span>&#8226; Assess voluntary pelvic floor contraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Consider early referral for further assessment&#58;</span><span class="elsevierStyleHsp" style=""></span>&#8226; UI associated with pain<span class="elsevierStyleHsp" style=""></span>&#8226; Visible &#40;&#63;&#41; haematuria<span class="elsevierStyleHsp" style=""></span>&#8226; Recurrent urinary tract infection<span class="elsevierStyleHsp" style=""></span>&#8226; Previous pelvic surgery or radiotherapy<span class="elsevierStyleHsp" style=""></span>&#8226; Constant leak suspicious of fistula<span class="elsevierStyleHsp" style=""></span>&#8226; Voiding difficulty<span class="elsevierStyleHsp" style=""></span>&#8226; Suspicion of neurological disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356422.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Given Grade A because&#44; despite absence of evidence&#44; expert opinion assigns absolute importance to these steps&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Recommendations for history taking and physical examination&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Voiding diaries should be used to evaluate coexisting storage and voiding dysfunction in clinical practice and research&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diary duration should be between 3 and 7 days&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356414.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Recommendations for voiding dairies&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do urinalysis as a part of the initial assessment of a patient with urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In a patient with urinary incontinence&#44; treat a symptomatic urinary tract infection appropriately &#40;see &#8216;<span class="elsevierStyleItalic">EAU Guidelines on Urological Infections</span>&#8217;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not treat asymptomatic bacteriuria in elderly patients to improve urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356415.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Recommendations for urinalysis and urinary tract infection&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post-voiding residual should be measured by ultrasound&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Measure post-voiding residual in patients with urinary incontinence who have voiding dysfunction&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Measure post-voiding residual when assessing patients with complicated urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post-voiding residual should be monitored in patients receiving treatments that may cause or worsen voiding dysfunction&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356426.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Recommendations for post-voiding residual volume&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinicians carrying out urodynamics in patients with urinary incontinence should&#58;<span class="elsevierStyleHsp" style=""></span>Ensure that the test replicates patient&#39;s symptoms<span class="elsevierStyleHsp" style=""></span>Interpret results in context of the clinical problem<span class="elsevierStyleHsp" style=""></span>Check recordings for quality control<span class="elsevierStyleHsp" style=""></span>Remember there may be physiological variability within the same individual&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Advise patients that the results of urodynamics may be useful in discussing treatment options&#44; although there is limited evidence that performing urodynamics will alter the outcome of treatment for urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not routinely carry out urodynamics when offering conservative treatment for urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perform urodynamics if the findings may change the choice of surgical treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perform urodynamics prior to surgery for urinary incontinence if there are either symptoms of overactive bladder&#44; a history of previous surgery or a suspicion of voiding difficulty&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not routinely carry out urethral pressure profilometry&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356418.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Recommendations for urodynamics&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use a pad test when quantification of urinary incontinence is required&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use repeat pad test if objective treatment outcome measure is required&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356417.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Recommendations for pad testing&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Table 7"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not routinely carry out imaging of the upper or lower urinary tract as part of the assessment of uncomplicated SUI in women&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356420.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Recommendation for imaging&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "tbl0040"
        "etiqueta" => "Table 8"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Take a drug history from all patients with urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inform women with urinary incontinence that begins or worsens after starting systemic oestrogen replacement therapy that it may cause urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Review any new medication associated with the development or worsening of urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356419.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Recommendations for simple clinical interventions&#46;</p>"
        ]
      ]
      10 => array:7 [
        "identificador" => "tbl0045"
        "etiqueta" => "Table 9"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">For adults with UI&#44; treat coexisting constipation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356423.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Recommendation for constipation&#46;</p>"
        ]
      ]
      11 => array:7 [
        "identificador" => "tbl0050"
        "etiqueta" => "Table 10"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">LE&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pads are not effective as a treatment for UI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Different pads have different advantages and disadvantages&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intermittent catheterisation carries a lower risk of urinary tract infection and bacteriuria than indwelling catheterisation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Containment devices are better than no treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There is not enough evidence to conclude which containment device is best&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Condom catheters are better than indwelling catheters if no residual urine is present&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There is no evidence to compare mechanical devices with other forms of treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356411.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Evidence on containment&#46;</p>"
        ]
      ]
      12 => array:7 [
        "identificador" => "tbl0055"
        "etiqueta" => "Table 11"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer pads when containment of urinary incontinence is needed&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adapt the choice of pad to the type and severity of urinary incontinence and the patient&#39;s needs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer catheterisation to manage urinary incontinence when no other treatments can be considered&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer condom catheters to men with urinary incontinence without significant residual urine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer to teach intermittent catheterisation to manage UI associated with retention of urine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not routinely offer intravaginal devices as treatment for incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not use penile clamps for control of UI in men&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356424.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Recommendations for containment&#46;</p>"
        ]
      ]
      13 => array:7 [
        "identificador" => "tbl0060"
        "etiqueta" => "Table 12"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer obese women suffering from any urinary incontinence weight reduction programmes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Advise adults with urinary incontinence that reducing caffeine intake may improve symptoms of urgency and frequency but not incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with abnormally high or abnormally low fluid intake should be advised to modify their fluid intake appropriately&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Counsel female athletes experiencing urinary incontinence with intense physical activity that it will not predispose to urinary incontinence in later life&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with urinary incontinence who smoke should be given smoking cessation advice in line with good medical practice although there is no definite effect on urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Recommendations for lifestyle interventions&#46;</p>"
        ]
      ]
      14 => array:7 [
        "identificador" => "tbl0065"
        "etiqueta" => "Table 13"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">LE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PFMT is better than no treatment for reducing incontinence episodes and improving quality of life in women with SUI&#44; and MUI&#46; There is no evidence that PFMT is better than no treatment in providing a cure</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Higher-intensity regimes&#44; or the addition of biofeedback&#44; confer greater benefit&#44; but differences are not sustained long term</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A taught&#47;supervised programme of PFMT is more effective than self-taught PFMT</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Group-based PFMT is as effective as treatment delivered individually</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Short-term benefits of intensive PFMT are not maintained at 15 years&#8217; follow-up</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PFMT compared with other conservative treatments</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT results in better reduction in leakage episodes than training using vaginal cones&#44; but no difference in self-reported cure or improvement&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT results in fewer incontinence episodes than electrical stimulation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT does not result in measurable improvement in quality of life&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT is better than bladder training for improvement of leakage and quality of life&#44; in women with SUI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>There is no consistent difference between PFMT and bladder training for women with UUI or MUI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT is as effective as duloxetine in women with SUI and has fewer side effects&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT is better tolerated than oxybutynin for UUI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT is better than alpha-agonists for women with SUI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PFMT in childbearing women</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT commencing in early pregnancy reduces the risk of incontinence in late pregnancy&#44; and up to 6 months post-partum&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PFMT commencing in the early postpartum period improves UI in women for up to 12 months&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PFMT in men</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men undergoing some form of PFMT&#44; before or after radical prostatectomy achieve continence more quickly than non-treated men&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>There is conflicting evidence on whether the addition of electrical stimulation or biofeedback or supervised training increases the effectiveness of PFMT alone&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>There is no evidence that pre-operative PFMT prevents UI following radical prostatectomy&#46; As with post-operative PFMT&#44; it appears to lead to earlier recovery of continence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Evidence on Pelvic Floor Muscle Therapy &#40;PFMT&#41; as monotherapy&#46;</p>"
        ]
      ]
      15 => array:7 [
        "identificador" => "tbl0070"
        "etiqueta" => "Table 14"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">PFMT&#44; pelvic floor muscle training&#59; PTNS&#44; posterior tibial nerve stimulation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer supervised PFMT&#44; lasting at least 3 months&#44; as a first-line therapy to women with stress or mixed urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PFMT programmes should be as intensive as possible&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Consider using biofeedback as an adjunct in women with stress urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer supervised PFMT to continent women in their first pregnancy to help prevent incontinence in the postnatal period&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer instruction on pelvic floor exercises to men undergoing radical prostatectomy to speed recovery of urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer bladder training as a first-line therapy to adults with urgency urinary incontinence or mixed urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer timed voiding to adults with urinary incontinence&#44; who are cognitively impaired&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not offer electrical stimulation with surface electrodes &#40;skin&#44; vaginal&#44; anal&#41; alone for the treatment of urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not offer magnetic stimulation for the treatment of urinary incontinence or overactive bladder in adult women&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not offer PTNS to women or men who are seeking a cure for UUI&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer&#44; if available&#44; PTNS as an option for improvement of UUI in women&#44; but not men&#44; who have not benefited from antimuscarinic medication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356421.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Recommendations for behavioural and physical therapies&#46;</p>"
        ]
      ]
      16 => array:7 [
        "identificador" => "tbl0075"
        "etiqueta" => "Table 15"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0145" class="elsevierStyleSimplePara elsevierViewall">IR&#44; immediate release&#59; ER&#44; extended release&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer IR or ER formulations of antimuscarinic drugs as an initial treatment option for adults with urgency urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">If IR formulations of antimuscarinic drugs are unsuccessful for adults with urgency urinary incontinence&#44; offer ER or long acting drugs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Consider using transdermal oxybutynin if oral antimuscarinic agents cannot be tolerated due to dry mouth&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer and encourage review of benefit within one month to patients started on antimuscarinic drugs for urgency urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inform elderly patients of the risk of new or worsened cognitive impairment and assess cognitive function in those deemed to be of higher risk&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Avoid using oxybutynin IR in patients who are at risk of cognitive impairment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use antimuscarinic drugs with caution in patients with cognitive impairment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356412.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Recommendations for antimuscarinic drugs&#46;</p>"
        ]
      ]
      17 => array:7 [
        "identificador" => "tbl0080"
        "etiqueta" => "Table 16"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetine should not be offered to women or men who are seeking a cure for their incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetine can be offered to women who are seeking temporary improvement in incontinence symptoms&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetine can be offered as an adjunct to PFMT for men with post-prostatectomy stress urinary incontinence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetine should be initiated using dose titration because of high adverse effect rates&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0150" class="elsevierStyleSimplePara elsevierViewall">Recommendations for duloxetine&#46;</p>"
        ]
      ]
      18 => array:7 [
        "identificador" => "tbl0085"
        "etiqueta" => "Table 17"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer postmenopausal women with urinary incontinence local oestrogen therapy&#44; although the ideal duration of therapy and best delivery method are uncertain&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab356409.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0155" class="elsevierStyleSimplePara elsevierViewall">Recommendations for oestrogen&#46;</p>"
        ]
      ]
      19 => array:7 [
        "identificador" => "tbl0090"
        "etiqueta" => "Table 18"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Offer desmopressin to patients requiring occasional situational short-term relief from urinary incontinence&#44; inform them that this drug is not licensed for this indication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Do not use desmopressin for long-term control of urinary incontinence&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab356425.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0160" class="elsevierStyleSimplePara elsevierViewall">Recommendations for desmopressin&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:98 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EAU guidelines on neurogenic lower urinary tract dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.eururo.2009.04.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2009"
                        "volumen" => "56"
                        "paginaInicial" => "81"
                        "paginaFinal" => "88"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Higgins JPT&#44; Green S &#40;Eds&#46;&#41;&#46; Cochrane handbook for systematic reviews of interventions&#44; v&#46;5&#46;1&#46;0&#46; Available from&#58; <a id="intr0025" class="elsevierStyleInterRef" href="http://www.cochrane-handbook.org/">www&#46;cochrane-handbook&#46;org</a> &#91;accessed March 2011&#93;&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "4th international consultation on incontinence"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2008"
                        "editorial" => "Health Publications"
                        "editorialLocalizacion" => "Plymouth&#44; UK"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of reliability of 1-day&#44; 3-day and 7-day frequency volume charts"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Urol Suppl"
                        "fecha" => "2004"
                        "volumen" => "3"
                        "paginaInicial" => "130"
                      ]
                    ]
                  ]
                ]
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Article information

ISSN: 21735786
Original language: English

DOI:10.1016/j.acuroe.2012.12.002

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2023 March	1	0	1
2018 February	12	1	13
2018 January	19	2	21
2017 December	14	1	15
2017 November	16	2	18
2017 October	25	5	30
2017 September	25	5	30
2017 August	23	8	31
2017 July	37	16	53
2017 June	27	15	42
2017 May	30	9	39
2017 April	30	21	51
2017 March	21	17	38
2017 February	42	8	50
2017 January	31	3	34
2016 December	52	8	60
2016 November	54	11	65
2016 October	63	13	76
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2016 August	34	9	43
2016 July	20	4	24
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2016 May	35	22	57
2016 April	39	10	49
2016 March	56	18	74
2016 February	37	20	57
2016 January	22	14	36
2015 December	34	16	50
2015 November	31	15	46
2015 October	27	15	42
2015 September	23	8	31
2015 August	29	5	34
2015 July	20	2	22
2015 June	6	5	11
2015 May	18	5	23
2015 April	18	2	20
2014 June	1	0	1
2014 May	2	1	3
2014 January	12	3	15
2013 December	25	2	27
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