Wiedemann A, Füsgen I
Urologische Abteilung, Evangelisches Krankenhaus Witten, Lehrstuhl für Geriatrie der Universität Witten/Herdecke.
Aktuelle Urol. 2009 Aug;40(4):242-6. doi: 10.1055/s-0028-1098911. Epub 2009 Jun 2.
In national and international guidelines the general practitioner plays an important role in the diagnosis and first-line therapy for urinary incontinence. Nevertheless, there is a lack of data concerning details of the management of incontinence in primary care in Germany. Therefore a series of nationwide educational events for general practitioners and gynaecologists was used to perform a survey dealing with the situation of urinary incontinence in general practice. With 2530 questionnaires filled out and returned, this is the largest European survey on this subject. General practitioners declare in 57.3 % to be often involved with urinary incontinence. They usually question elderly patients about urinary incontinence (73.7 %) or those patients with diseases carrying the risk of developing urinary incontinence (64.9 %). Based on the diagnostic options in primary care, an incontinence anamnesis and urine evaluation are performed. A sonography or micturition diary was more infrequent in primary care in this survey. General practitioners most frequent refer the patient to a specialist (76.6 %) or prescribe the incontinence-type anticholinergic drugs (59.4 %) or absorbent products (45.4 %); duloxetine (27.3 %) is less frequently prescribed. The knowledge about urinary incontinence is gained in educational events (72.2 %); the course of studies was the source of incontinence skills for general practitioners only in 35 %. In conclusion, this survey gives a realistic view on the incontinence management in primary care in Germany. The majority of general practitioners are engaged in incontinence, perform basic diagnostic features and prescribe drugs or absorbent products. The course of (university medical school) studies as a source of skills to diagnose or to treat incontinence should be improved.
在国内和国际指南中，全科医生在尿失禁的诊断和一线治疗中发挥着重要作用。然而，德国缺乏关于初级保健中尿失禁管理细节的数据。因此，针对全科医生和妇科医生举办了一系列全国性教育活动，以开展一项关于全科医疗中尿失禁情况的调查。回收了2530份填写并返回的问卷，这是欧洲关于该主题规模最大的调查。全科医生宣称57.3%的人经常处理尿失禁问题。他们通常会询问老年患者（73.7%）或有患尿失禁风险疾病的患者（64.9%）是否存在尿失禁。基于初级保健中的诊断选项，会进行尿失禁问诊和尿液评估。在本次调查中，超声检查或排尿日记在初级保健中较少使用。全科医生最常将患者转诊给专科医生（76.6%），或开具抗胆碱能类尿失禁药物（59.4%）或吸收性产品（45.4%）；度洛西汀的处方频率较低（27.3%）。关于尿失禁的知识是通过教育活动获得的（72.2%）；只有35%的全科医生表示其失禁相关技能来源于医学课程学习。总之，本次调查真实反映了德国初级保健中尿失禁的管理情况。大多数全科医生参与尿失禁的诊治，进行基本的诊断并开具药物或吸收性产品。作为诊断或治疗失禁技能来源的（大学医学院）课程学习应该得到改进。
