[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Optimal bladder emptying, including timed voiding and possibly evaluation of postvoid residual, is recommended during labor and postpartum, even in asymptomatic women with prolonged voiding intervals. [Expert opinion] This is based on expert consensus from the ICS terminology report.
[WEAK recommendation, LOW evidence] [Weak recommendation] Avoiding instrumental deliveries and preferring ventouse over forceps may be considered to reduce the risk of pelvic floor trauma. [Low evidence] This is based on observational data and expert opinion, as per the ICS terminology report.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Perineal massage may be considered antenatally or during the second stage of labor to stretch perineal structures, depending on patient preference and clinical context. [Low evidence] This is based on limited observational data and expert opinion from the ICS terminology report.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Maintain vulval hygiene by regular washing with avoidance of irritants like shampoo, perfumed creams, or soap, and wear cotton underwear. [Expert opinion] This is based on expert consensus from the ICS terminology report.
[Strong recommendation] Shampoo, perfumed creams, or soap should be avoided to prevent vulval irritation. [Low evidence] Based on expert opinion or observational studies.
[Moderate recommendation] Use soft toilet paper or moist wipes without alcohol, wipe from front to back, wash after bowel movements, and pat dry. [Low evidence] Based on expert opinion or observational studies.
[Moderate recommendation] Delaying pushing after full dilation may allow spontaneous fetal descent and rotation, increasing pushing efficiency and reducing maternal fatigue and instrumental delivery risk. [Moderate evidence] Based on a referenced study, likely an RCT or strong observational data.
[Weak recommendation] Perineal massage and pelvic floor muscle training may be considered for prevention, but are controversial due to unclear benefit-risk balance. [Low evidence] Based on observational studies or expert opinion with conflicting results.
[Weak recommendation] Dietary changes, weight loss, increased physical activity, and smoking cessation may improve overall health and help with ED comorbidities. [Expert Opinion] Based on consensus or general health guidelines without direct high-quality evidence.
[Strong recommendation based on expert opinion] History should include duration of symptoms, identification of disorder, impact on quality of life, and partner relationship.
[Strong recommendation based on expert opinion] Diagnosis should be made only after two total testosterone measurements taken on separate occasions, both conducted in the morning.
[Strong recommendation based on expert opinion] Diagnosis should include at least three of six specified criteria related to reduced sexual interest, thoughts, initiation, excitement, arousal, or sensations.
[No Recommendation] This document does not provide clinical treatment recommendations with graded strength or evidence levels. It is a terminology standardization report defining assessment parameters, diagnostic criteria, and measurement techniques for pelvic floor muscle function and dysfunction. [Expert Opinion] Based on ICS consensus and literature review for terminology standardization.
[Weak recommendation] Dye tests may be considered for detecting small or unusual fistulas, such as utero-vaginal or cervico-vaginal fistulas, and for differentiating types of fistulas. [Expert Opinion] This is based on expert consensus from the ICS standards.
[Weak recommendation] Lifestyle interventions may be considered for managing chronic incontinence, particularly in women who are not candidates for surgical treatment. [Expert Opinion] This recommendation is based on expert consensus from the ICS standards.
[Moderate recommendation] Principles such as patient counseling, optimizing patient health, and careful tissue handling should be followed in all fistula surgeries to improve outcomes. [Expert Opinion] This is based on expert consensus from the ICS standards.
[Moderate recommendation] Based on expert opinion, it is recommended that all aspects in the checklist (Box 1) should be reported to enable reproducibility of assessment.
[Moderate recommendation] Based on expert opinion, terms indicating alterations to normal muscle tone should be differentiated based on the presence or absence of a neurological disorder.
[CONDITIONAL recommendation, VERY LOW evidence] [Conditional recommendation] Immediate repetition is recommended when there is doubt about the test answering the clinical question or when technical errors are observed during post-test analysis. [Very low evidence] Based on expert opinion due to a lack of definitive evidence from clinical studies.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] BOO can be detected using transabdominal ultrasound by measuring detrusor wall thickness (DWT) ≥2mm in bladders filled with ≥250mL or bladder wall thickness (BWT) ≥5mm in bladders filled with 150mL. [Low evidence] Based on observational studies and clinical series.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Low bladder compliance is defined as <10 mL/cmH2O for neurogenic and <30 mL/cmH2O for non-neurogenic cases, with normal compliance >30 mL/cmH2O and 40 mL/cmH2O, respectively. [Expert opinion] Based on ICS standards consensus without direct clinical trial evidence.
[Strong recommendation] It is strongly recommended to describe all aspects of intermittent catheterization techniques completely in clinical research. [Expert Opinion] Based on ICS Working Group consensus to address lack of standardization.
[Strong recommendation] A comprehensive physical examination should be performed, including abdominal and pelvic assessment to identify pain sources. [Expert Opinion] Based on ICS Standard consensus for chronic pelvic pain syndromes.
[Strong recommendation] Nocturia should be quantified using a bladder diary. [Moderate evidence] Based on ICS terminology standards derived from research and consensus.
[Strong recommendation] Pain ratings are essential for evaluation, including regular assessment of severity and quality of life. [Expert Opinion] Based on ICS Standard consensus for chronic pelvic pain syndromes.
[Strong recommendation] Examinations for pelvic organ prolapse should be performed with the woman's bladder empty. [Expert Opinion] This is based on expert consensus from the ICS/IUGA terminology standards.
[Strong recommendation] During digital rectal examination, the gloved finger should be placed in the center of the anus with the finger parallel to the skin of the perineum in the midline. [Expert Opinion] This recommendation is derived from expert consensus in the ICS/IUGA terminology standards for anorectal dysfunction.
[Strong recommendation] Every study evaluating pelvic organ prolapse surgery should report perioperative data, subjective outcomes, objective outcomes, secondary outcomes, and surgery type and operated compartment. [Expert Opinion] This is based on expert consensus from the IUGA-ICS report on outcome measures.
[Moderate recommendation] Endoanal ultrasound (EAUS) is recommended as the first-line imaging investigation for fecal incontinence to assess anal sphincter integrity, based on moderate evidence from Level II studies.
[Moderate recommendation] Yes, assessment of anal reflex and perianal sensation should be performed in patients with ano-rectal dysfunction, particularly when neurogenic causes are suspected, based on expert opinion and clinical practice standards.
[Weak recommendation] The Bristol stool chart may be considered useful for patient conversations about stool consistency, but evidence is very low as it lacks validation for outcome measurement and precision in clinical trials.
[Moderate recommendation] Anorectal manometry is recommended for assessing anal sphincter function in fecal incontinence, particularly to define weakness, support other tests, and monitor biofeedback training, based on low evidence from observational studies.
[Strong recommendation] Sexual concerns should be addressed routinely to improve sexual health management, based on expert consensus.
[Strong recommendation] A comprehensive medical and psychosocial history, ideally including both partners, is essential for evaluating sexual dysfunction, based on expert opinion.
[Strong recommendation] Water-filled catheter and external transducer is recommended by the ICS for urodynamic pressure measurement, based on expert consensus.
[Moderate recommendation] The ICS suggests that urodynamic tests should be displayed on a 1mm per 5sec scale for filling and 1mm per 2sec for voiding, based on expert opinion.
[Weak recommendation] Lubricants and moisturizers may assist with atrophic symptoms and dyspareunia, based on low-quality evidence from referenced studies.
[Moderate recommendation] It is recommended that clinical research studies address entry criteria, design, methodology, power, and absence of bias to ensure reliability of findings. [Expert opinion] This is based on consensus from the IUGA/ICS joint report.
[Moderate recommendation] Equipment should be calibrated for reliable results, based on expert opinion from ICS standards.
[Moderate recommendation] Patients should complete a 3-day bladder diary in advance, based on expert opinion from ICS standards.
[Moderate recommendation] Pressure traces should be scrutinized throughout the study to confirm genuine pressure recordings, based on expert opinion from ICS standards.
[Moderate recommendation] A suitable environment including waiting areas, privacy, and hygiene should be provided, based on expert opinion from ICS standards.
[Strong recommendation] The trace must be scrutinized after the test to confirm that pressure and flow values accurately reflect urinary tract function, based on expert opinion from ICS standards.
[Strong recommendation] Physical examination must include abdominal, pelvic and perineal examination. [Expert Opinion] This is based on clinical consensus to identify relevant physical signs and localize neurological deficits.
[Moderate recommendation] Urodynamic testing provides a valuable insight into mechanisms and may identify health risks. [Moderate evidence] This is based on clinical studies and the complex pathophysiology of NLUTD.
[Strong recommendation] A thorough history is crucial, including pain duration (≥6 months), inciting events, triggers, character, radiation, and severity. [Expert Opinion] This is based on clinical consensus to systematically evaluate pain domains and guide further assessment.
[Strong recommendation] The Pelvic Organ Prolapse Quantification (POP-Q) system should be used to describe pelvic organ prolapse. [Expert Opinion] This is based on ICS/IUGA consensus to ensure standardized assessment and reporting.
[Strong recommendation] Urodynamic centers should provide a suitable uroflowmetry testing environment, including privacy, cleanliness, and immediate access. [Expert Opinion] This is based on ICS guidelines to optimize test quality and patient comfort.
[STRONG recommendation] The operator should move the Qmax marker or smooth the flow signal by eye to establish clinically representative values. [EXPERT OPINION] This is based on ICS standards and clinical practice guidelines.
[MODERATE recommendation] A moving average with a 2-second window is advised for smoothing flow signals. [EXPERT OPINION] Based on ICS standards and referenced guidelines.
[STRONG recommendation] The report should include voiding position, corrected Qmax, voided volume, and post-void residual. [EXPERT OPINION] This follows ICS standard reporting formats.
[CONDITIONAL recommendation] Consider repeating uroflowmetry if the result is not representative or indicates abnormality. [EXPERT OPINION] Based on clinical judgment and referenced guidelines.
[STRONG recommendation] Calibrate pressure transducers with a pressure difference of ≥50 cmH2O and verify regularly. [EXPERT OPINION] Based on ICS equipment performance guidelines.
[CONDITIONAL recommendation] Consider videourodynamics for patients with neurological disease, congenital anomalies, complex bladder outflow obstruction, or other specific indications. [EXPERT OPINION] Based on expert consensus and guideline recommendations.
[STRONG recommendation] Yes, the use of a bladder diary is highly recommended for documenting symptoms like frequency, volume, and incontinence episodes. [MODERATE evidence] This is based on Level 2 evidence with a Grade A rating from the Oxford grading system.
[STRONG recommendation] Yes, the ICIQ is highly recommended for the basic evaluation of patient perspectives on urinary incontinence. [HIGH evidence] This recommendation is based on GoR A, indicating high-quality evidence from studies like RCTs.
[MODERATE recommendation] Uroflowmetry is recommended as a screening test for symptoms of voiding dysfunction or related signs. [EXPERT OPINION] This recommendation is based on expert consensus from clinical guidelines.
[STRONG recommendation] Yes, pelvic floor muscle training is recommended for children with urinary incontinence, as indicated by a Grade A rating. [MODERATE evidence] This is based on evidence reviewed by the committee, likely from studies like observational cohorts or RCTs.
[Strong recommendation] Yes, pelvic floor muscle exercises should be provided to pregnant women to prevent urinary and fecal incontinence. [High evidence] This is based on high-level evidence from multiple randomized controlled trials or systematic reviews.
[Strong recommendation] Yes, education designed for community-dwelling older women should be provided to prevent urinary incontinence. [High evidence] This is supported by high-level evidence from randomized controlled trials.
[Weak recommendation] Care delivery models should be based on the principles described in the Optimum Continence Service Specification. [Low evidence] This recommendation is based on lower-quality evidence or expert consensus.
[Weak recommendation] Increased emphasis is needed on non-physician models of care, including nursing, physiotherapy, and other providers. [Low evidence] This is based on lower-quality evidence or expert consensus.
[Strong recommendation] Yes, an inter-disciplinary discussion is strongly recommended to assess feasibility and optimal timing for surgery. [Expert opinion] This recommendation is based on consensus from the ICS working group using nominal group technique.
[Strong recommendation] Yes, a cognitive and prognosis assessment should be performed as part of the global assessment. [Expert opinion] This is based on ICS working group consensus to ensure patient suitability.
[Strong recommendation] Yes, pre-operative overnight fasting should be avoided, and an ERAS protocol should be used. [Moderate evidence] This is based on ERAS literature and ICS working group consensus to enhance recovery.
[Strong recommendation] Yes, all patients must be discussed with a specialist IBD multi-disciplinary team to assess feasibility and bowel segment selection. [Expert opinion] This is based on ICS working group consensus to optimize surgical outcomes.
[WEAK recommendation, LOW evidence] [Weak recommendation] The combined use may be considered with careful observation, but the evidence is limited and mixed.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] TURP should be avoided due to the risk of urinary incontinence from detrusor underactivity and impaired sphincter function.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Alpha-blockers must be used with caution due to the risk of exacerbating postural hypotension, based on low evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Treatment selection should be patient-centered and aligned with goals of care, considering life expectancy, risk/benefit, and quality of life. [Expert opinion] This is based on consensus from ethical guidelines and expert opinion.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Patients and caregivers must be fully informed of all risks, benefits, and impacts on quality of life for each treatment option. [Expert opinion] This stems from ethical guidelines and expert consensus.
[STRONG recommendation, LOW evidence] [Strong recommendation] Overutilization of diagnostic testing and overdiagnosis should be avoided to prevent patient harm and resource waste. [Low evidence] This is supported by observational studies and expert opinion on minimizing unnecessary interventions.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Comprehensive physical, cognitive, and situational assessments are an ethical imperative to ensure safe and patient-centered management plans. [Expert opinion] This is grounded in consensus from ethical guidelines and expert opinion.
[STRONG recommendation, LOW evidence] [Strong recommendation] Skills for 'caring self-protection' should be systematically mapped and included in caregiver training programs to minimize harm and ensure good care. [Low evidence] This is supported by observational research and pilot studies, such as Vaittinen's work.
[Moderate recommendation] Adults with urinary incontinence should be assessed by a healthcare practitioner for lifestyle, risk factors, and quality of life to identify the type of bladder dysfunction. [Moderate evidence] Based on studies showing bladder training as an effective behavioral therapy.
[Moderate recommendation] The bladder training program should be structured and supervised, with a duration of at least 6 weeks, tailored to the person's progress and goals. [Low evidence] Based on clinical guidelines with limited evidence.
[Strong recommendation] Urge suppression should involve relaxation (e.g., slow breathing), pelvic floor muscle contractions (5-8 fast contractions), and distraction techniques. [Moderate evidence] Based on well-designed controlled trials showing 50-80% reduction in urinary incontinence episodes.
[Moderate recommendation] Healthcare practitioners should conduct an assessment of bowel symptoms to identify the cause and type of bowel dysfunction before recommending a bowel training program. [Expert opinion] Based on consensus and clinical guidelines.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Prophylactic antibiotics should be administered within 60 minutes of incision for all AUS procedures to ensure low bacterial counts. [Expert opinion] This is based on consensus guidelines from the International Continence Society.
[STRONG recommendation, HIGH evidence] [Strong recommendation] Desmopressin is recommended as the only evidence-based pharmaceutical therapy for nocturia. [High evidence] This is supported by level 1a evidence from multiple randomized controlled trials.
[STRONG recommendation, HIGH evidence] [Strong recommendation] CPAP is recommended for patients with OSAS to treat associated nocturia. [High evidence] This is based on level 1a evidence from clinical trials.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] It is necessary to use a bladder diary to demonstrate nocturnal polyuria before prescribing desmopressin. [Expert opinion] This is based on consensus from a Delphi panel of experts.
[WEAK recommendation, LOW evidence] [Weak recommendation] Lifestyle interventions may be considered for some patients with nocturia, depending on the underlying cause. [Low evidence] This is based on limited observational studies or expert opinion.
[Strong recommendation] SNM is recommended for patients with OAB, with or without incontinence, who do not respond to or are intolerant of conservative and medical treatments. [High evidence] This is supported by multiple randomized controlled trials.
[Strong recommendation] SNM is recommended as an effective treatment for Fowler’s Syndrome, voiding dysfunction, and non-obstructive urinary retention. [High evidence] This recommendation is based on high-quality randomized controlled trials.
[Weak recommendation] SNM may be considered as an option for patients with interstitial cystitis/bladder pain syndrome who do not respond to conservative therapies, after proper assessment. [Low evidence] This is based on observational studies and case series.
[Moderate recommendation] SNM should be considered as a second-line treatment for bothersome fecal incontinence after conservative measures have failed. [Moderate evidence] This is supported by prospective cohort studies and some randomized trials.
[Moderate recommendation] The trial phase (PNE or staged lead) is the key tool for predicting therapeutic success in urinary indications. [Moderate evidence] This is based on cohort studies and clinical trials.
[WEAK recommendation, LOW evidence] [Weak recommendation] LASER is not recommended for vaginal atrophy or rejuvenation due to unknown mechanism of action and insufficient evidence.
[WEAK recommendation, VERY LOW evidence] [Weak recommendation] Histological changes after LASER therapy should not be used to justify treatment, as they may not represent functional restoration and evidence is very low.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] LASER is not recommended to improve the vaginal microbiome, although it does not negatively impact it, based on moderate evidence.
[WEAK recommendation, LOW evidence] [Weak recommendation] LASER is not recommended for treating vaginal atrophy due to insufficient evidence on efficacy and safety, based on low evidence.
[NO RECOMMENDATION recommendation, VERY LOW evidence] [No recommendation] LASER is not recommended for stress urinary incontinence or pelvic organ prolapse due to limited evidence and safety data, based on very low evidence.
[NO RECOMMENDATION recommendation, VERY LOW evidence] [No recommendation] LASER is not recommended for vaginal laxity due to no supporting data on efficacy or safety, based on very low evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] LASER is not recommended to improve pain in vulvodynia, based on moderate evidence.
[WEAK recommendation, VERY LOW evidence] [Weak recommendation] CO2 LASER is not recommended for vulvar lichen sclerosus due to no supporting data on efficacy or long-term safety, based on very low evidence.
[WEAK recommendation, VERY LOW evidence] [Weak recommendation] LASER is not recommended for vulvar bleaching due to no medical indication and insufficient safety data, based on very low evidence.
[Strong recommendation] Urinary catheters should be inserted only for appropriate indications and should be removed as soon as they are no longer needed. [Low evidence] This is based on low quality evidence from observational studies and expert consensus, showing reduced risk of catheter-associated urinary tract infections with appropriate use.
[Strong recommendation] Urinary catheters should be avoided for managing incontinence in patients and nursing home residents. [Low evidence] This is based on low quality evidence from observational studies indicating higher risks of urinary tract infections with catheter use in this context.
[Weak recommendation] External catheters may be considered as an alternative to indwelling urethral catheters for cooperative male patients without urinary retention or bladder outlet obstruction. [Low evidence] This suggestion is based on low quality evidence from studies comparing infection risks and patient comfort.
[Strong recommendation] After aseptic insertion, a closed drainage system should be maintained for urinary catheters. [Low evidence] This is based on low quality evidence from observational studies demonstrating that closed systems reduce the risk of catheter-associated urinary tract infections.
[Strong recommendation] Urinary catheters should be used only as necessary in operative patients, rather than routinely. [Low evidence] Based on low-quality evidence from systematic reviews and observational studies.
[Moderate recommendation] Alternatives such as intermittent catheterization should be considered in spinal cord injury patients. [Very low evidence] Based on very low-quality evidence from observational studies.
[Strong recommendation] Clean (non-sterile) technique is acceptable and preferable for intermittent catheterization in non-acute care settings. [Moderate evidence] Based on moderate-quality evidence from RCTs and observational studies.
[Strong recommendation] Systemic antimicrobials should not be used routinely for UTI prophylaxis in patients with short or long-term catheterization. [Low evidence] Based on low-quality evidence from systematic reviews and RCTs.
[No Recommendation] Insufficient evidence to recommend for or against using a urethral stent as an alternative to an indwelling catheter in selected patients with bladder outlet obstruction. [Very low evidence] Based on very low-quality evidence from an observational study.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] Coughing should be repeated three more times for a total of four coughs before calling the test negative. [Moderate evidence] Based on level 2 evidence and grade B recommendation.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Measuring and reporting of DLPP should be part of cystometric evaluation in children and adults with neurogenic lower urinary tract dysfunction to help predict and prevent upper urinary tract deterioration. [Low evidence] Based on grade B/C recommendation and low-level evidence from retrospective cohort studies.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Measurement of post-void residual urine is recommended in the management of female urinary incontinence. [Low evidence] Based on level 3 evidence.
[WEAK recommendation, EXPERT OPINION evidence] [Weak recommendation] One-hour pad tests are most suitable for establishing initial diagnosis, while 24-hour tests serve for evaluating treatment outcomes, and longer tests are used in clinical studies. [Expert opinion] Based on expert consensus due to lack of high-quality evidence.
[Weak recommendation] Providing complete catheter information to users is suggested to improve awareness and self-care, based on observational studies showing knowledge gaps [Low evidence].
[Weak recommendation] Using appropriate catheter balloon size and water inflation is recommended to prevent complications like erosion, based on observational studies highlighting knowledge gaps [Low evidence].
[Conditional recommendation] Teaching catheter changes to patients and caregivers may be considered based on individual criteria like dexterity and need, as observational studies show variability in practice [Low evidence].
[Conditional recommendation] Monitoring catheter self-care capability over time may be considered, especially in patients with conditions like multiple sclerosis where disability changes, to identify caregiver needs [Low evidence].
[Moderate recommendation] Implementing a simplified self-management intervention, including a self-monitoring calendar and optimal consistent fluid intake, is suggested based on a randomized clinical trial showing reduced catheter blockage [Moderate evidence].
[Moderate recommendation] Yes, they should be taught to monitor urine flow, fluid intake, and catheter-related changes to prevent problems. [Low evidence] This is based on a single study with observational data.
[Strong recommendation] Complete patient history, clinical examination, bladder diary, uroflowmetry, and post-void residual (PVR) should be available. [Expert Opinion] This is based on clinical practice guidelines.
[Moderate recommendation] A 5-6Fr double lumen catheter and a filling rate of ±10% per minute of expected bladder capacity are preferred. [Expert Opinion] Based on clinical standards.
[Strong recommendation] It should be performed in the sitting position. [Expert Opinion] This is based on clinical guidelines.
[Moderate recommendation] Medication or sedation use should be accounted for and included in the report. [Expert Opinion] This is based on clinical standards to ensure accurate evaluation.
[Conditional recommendation] Elective cesarean section before the onset of labor may be considered as a primary prevention strategy for perineal trauma, based on expert opinion.
[Moderate recommendation] Cystoscopy with hydrodistension is probably important for subclassifying Bladder Pain Syndrome, based on expert opinion.
[Strong recommendation] Questionnaires like the Visual Analog Scale for pain and laboratory testing including culture and complete blood count should be used in the evaluation of chronic pain syndromes, based on expert opinion.
[Moderate recommendation] Manual therapy is effective for improving sexual function in women with pelvic floor disorders, based on moderate evidence from meta-analyses and systematic reviews.
[Strong recommendation] Assessment of sexual activity and partner status before and after surgical treatment is essential for evaluating outcomes, based on expert opinion from clinical guidelines.
[Weak recommendation] Clitoral suction devices may improve arousal, orgasm, and satisfaction in patients with sexual arousal disorder, based on low evidence from small non-blinded studies.
[Weak recommendation] Lifestyle modifications such as weight loss, adequate sleep, physical fitness, and mood management may improve sexual function, based on low evidence from observational data or expert opinion.
[Weak recommendation] Psychological interventions such as counseling, sex therapy, and cognitive behavioral therapy may improve sexual function, based on low evidence from available studies despite insufficient controlled trials.
[Moderate recommendation] General lifestyle advice such as reducing caffeine and alcohol intake may be considered, but care should be taken to avoid general fluid restriction due to potential risks. Patients should be encouraged to return for further evaluation if not satisfied. [Expert Opinion] Based on consensus guidelines without explicit evidence citation.
[Weak recommendation] The use of an information leaflet may be considered to facilitate informed decision making. [Low evidence] Based on limited observational data or expert opinion.
[Conditional recommendation] Delayed pushing after full dilation may be considered to allow spontaneous fetal descent and reduce risks of fatigue and instrumental delivery. [Expert Opinion] Based on clinical guidelines without explicit evidence.
[Strong recommendation] Digital rectal examination is recommended as part of the physical examination for males. [Expert Opinion] This recommendation is based on clinical guidelines and expert consensus.
[Conditional recommendation] ICS does not recommend routine immediate repetition of urodynamic tests if the initial test was technically adequate and answered the clinical question. However, [Strong recommendation] repetition is recommended when there is doubt about the test's validity or when technical errors are observed. [Expert Opinion] This is based on expert consensus due to lack of convincing evidence for routine repetition.