The evaluation and treatment of female urinary incontinence--a comparison of clinical practice in the Republic of Ireland with the recommendations of the International Continence Society.

In 1998 the International Continence Society (ICS) developed a set of recommendations for the diagnostic evaluation and treatment of urinary incontinence. The aim of this study was to determine to what extent current clinical practice in the Republic of Ireland correlated with the ICS recommendations. We personally interviewed 100 gynaecologists at units around Ireland. Participants were presented with two clinical scenarios, one described a patient with predominantly genuine stress incontinence, the other described a patient with an overactive bladder. Ninety-five (95%) requested a midstream urine sample for culture and sensitivity, and 74 (74%) considered urodynamics an appropriate initial investigation for a woman with stress incontinence. Physiotherapy was recommended as a first line treatment for stress incontinence by 76 (76%). Burch colposuspension, chosen by 55 (55%), was the most common first line surgical procedure. Other first line surgical procedures were TVT [31(31%)] Marshall-Marchetti-Krants procedure [5(5%)], anterior colporrhaphy [4 (4%)] and a variety of other procedures [5 (5%)]. When considering the initial investigation for a woman with an overactive bladder, 95 (95%) asked for a midstream urine sample for culture and sensitivity and 85 (85%) requested urodynamic investigations. Initial management of this condition included anticholinergic therapy alone [57 (57%)], anticholinergic therapy combined with bladder retraining [36 (36%)], bladder retraining alone [5 (5%)], and cystoscopy and bladder distension 2 (2%). Seventy-six (76%) felt that cystoscopy was an appropriate investigation for a woman with symptoms of an overactive bladder who has failed to respond to initial therapy. The study reveals a significant degree of diversity in the evaluation and management of patients who present with symptoms of urinary incontinence. It also highlights a number of areas where current clinical practice deviates from the recommendations of the ICS. In particular, there is a high and inappropriate use of urodynamics in the initial management of these patients.