[STRONG recommendation, MODERATE evidence] [Strong recommendation] Clinicians should counsel patients regarding the risk of sexual arousal incontinence and climacturia following localized prostate cancer treatment. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[STRONG recommendation, HIGH evidence] [Strong recommendation] Clinicians should inform patients undergoing radical prostatectomy that incontinence is expected in the short-term and generally improves to near baseline by 12 months after surgery but may persist and require treatment. [High evidence] This is based on Grade A evidence, indicating high certainty.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should inform patients undergoing radical prostatectomy or transurethral resection of the prostate after radiation therapy of the high rate of urinary incontinence following these procedures. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] In patients with bothersome stress urinary incontinence after prostate treatment, clinicians may offer surgery as early as six months if incontinence is not improving despite conservative therapy. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] In patients with bothersome stress urinary incontinence after prostate treatment despite conservative therapy, clinicians should offer surgical treatment at one year post-prostate treatment. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Clinicians should evaluate patients with incontinence after prostate treatment with history, physical exam, and appropriate diagnostic modalities to categorize type and severity of incontinence and degree of bother. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] In patients with urgency urinary incontinence or urgency predominant mixed urinary incontinence, clinicians should offer treatment options per the American Urological Association Overactive Bladder Guideline. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Prior to surgical intervention for stress urinary incontinence, clinicians should confirm stress urinary incontinence by history, physical exam, or ancillary testing. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Clinicians should inform patients with incontinence after prostate treatment of management options for their incontinence, including surgical and non-surgical options. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] In patients with incontinence after prostate treatment, clinicians should discuss risk, benefits, and expectations of different treatments using the shared decision-making model. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Prior to surgical intervention for stress urinary incontinence, clinicians should perform cystourethroscopy to assess for urethral and bladder pathology that may affect outcomes of surgery. [Expert opinion] This is based on Expert Opinion, indicating consensus without direct evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may perform urodynamic testing in patients prior to surgical intervention for stress urinary incontinence in cases where it may facilitate diagnosis or counseling. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] In patients seeking treatment for incontinence after radical prostatectomy, clinicians should offer pelvic floor muscle exercises or pelvic floor muscle training. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] Clinicians should discuss the option of artificial urinary sphincter with patients who are experiencing mild to severe stress urinary incontinence after prostate treatment. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] Clinicians should discuss the option of male slings with patients as treatment options for mild to moderate stress urinary incontinence after prostate treatment. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should not routinely implant male slings in patients with severe stress incontinence. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may offer adjustable balloon devices to non-radiated patients with mild to severe stress urinary incontinence after prostate treatment. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should manage patients with stress urinary incontinence after treatment of benign prostatic hyperplasia the same as patients that have undergone radical prostatectomy. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] In patients with stress urinary incontinence after primary, adjuvant, or salvage radiotherapy who are seeking surgical management, clinicians should offer artificial urinary sphincter over male slings or adjustable balloons. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] In patients with incontinence after prostate treatment, clinicians should counsel patients that efficacy is low and cure is rare with urethral bulking agents. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Clinicians should consider other potential treatments for incontinence after prostate treatment as investigational, and patients should be counseled accordingly. [Expert opinion] This is based on Expert Opinion, indicating consensus without direct evidence.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] In patients with persistent or recurrent urinary incontinence after artificial urinary sphincter or sling, clinicians should again perform history, physical examination, and/or other investigations to determine the cause of incontinence. [Expert opinion] This is based on Clinical Principle, indicating expert consensus.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] In patients with persistent or recurrent stress urinary incontinence after sling, clinicians should recommend an artificial urinary sphincter. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] In patients with persistent or recurrent stress urinary incontinence after artificial urinary sphincter, clinicians should discuss artificial urinary sphincter revision with the patient. [Moderate evidence] This is based on Grade B evidence, indicating moderate certainty.
[MODERATE recommendation, EXPERT OPINION evidence] [Moderate recommendation] Clinicians should discuss urinary diversion with patients who are unable to obtain long-term quality of life due to incontinence after prostate treatment. [Expert opinion] This is based on Expert Opinion, indicating consensus without direct evidence.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] In patients with bothersome incontinence during sexual activity, clinicians should offer treatment. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] In patients with stress urinary incontinence following urethral reconstructive surgery, clinicians may offer artificial urinary sphincter and counsel that complication rates are higher. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] In patients with incontinence after prostate treatment and erectile dysfunction, clinicians may offer a concomitant or staged procedure. [Low evidence] This is based on Grade C evidence, indicating low certainty.
[STRONG recommendation] Clinicians should discuss incontinence management strategies, such as pads or barrier creams, with all patients who have urgency urinary incontinence. [EXPERT OPINION evidence] This is based on expert opinion.
[WEAK recommendation] Clinicians should not offer stem cell therapy for stress incontinence outside of investigative protocols. [EXPERT OPINION evidence] Based on expert consensus due to insufficient data.
[CONDITIONAL recommendation] Clinicians may perform any incontinence procedure, such as midurethral sling, pubovaginal sling, or Burch colposuspension, during concomitant pelvic prolapse repair. [LOW evidence] Based on Grade C evidence from studies like CARE and OPUS trials.
[Weak recommendation] Bulking agents should not be offered to men with post-prostatectomy incontinence. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[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] 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] 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] 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.
[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.
[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] 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.
[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.
[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.
[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.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] The decision should involve shared decision-making after reviewing risks and benefits, based on [Moderate evidence] from RCTs and systematic reviews.
[Weak recommendation] Lifestyle advice should be offered to men with UI, but patients should be informed that evidence is lacking. [LOW evidence] Based on limited or observational studies.
[Strong recommendation] Antimuscarinic drugs or mirabegron should be offered to adults with urgency UI who failed conservative treatment. [EXPERT OPINION evidence] Based on EAU guideline consensus.
[WEAK recommendation, LOW evidence] [Weak recommendation] The combined use may be considered with careful observation, but the evidence is limited and mixed.
[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.
[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.
[STRONG recommendation] Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and incontinence. [HIGH evidence] This is based on multiple randomized controlled trials with consistent results.
[Strong recommendation] Urinalysis, blood chemistry, bladder diary, post-void residual, incontinence quantification, and urinary tract imaging should be performed. [Expert opinion] Based on EAU guideline consensus.
[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, MODERATE evidence] [Strong recommendation] TURP should be avoided due to the risk of urinary incontinence from detrusor underactivity and impaired sphincter function.
[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.
[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.