Service de Gynécologie-Obstétrique, CHU Jean Bernard, F-86021 Poitiers cedex, France.
Eur J Obstet Gynecol Reprod Biol. 2010 Jul;151(1):14-9. doi: 10.1016/j.ejogrb.2010.02.041. Epub 2010 Mar 16.
Urinary incontinence is a frequent affliction in women and may be disabling and costly {LE1}. When consulting for urinary incontinence, it is recommended that circumstances, frequency and severity of leaks be specified {Grade B}. The cough test is recommended prior to surgery {Grade C}. Urodynamic investigations are not needed before lower urinary tract rehabilitation {Grade B}. A complete urodynamic investigation is recommended prior to surgery for urinary incontinence {Grade C}. In cases of pure stress urinary incontinence, urodynamic investigations are not essential prior to surgery provided the clinical assessment is fully comprehensive (standardised questionnaire, cough test, bladder diary, post-void residual volume) with concordant results {PC}. It is recommended to start treatment for stress incontinence with pelvic floor muscle training {Grade C}. Bladder training is recommended at first intention in cases with overactive bladder syndrome {Grade C}. For overweight patients, loss of weight improves stress incontinence {LE1}. For surgery, sub-urethral tape (retropubic or transobturator route) is the first-line recommended technique {Grade B}. Sub-urethral tape surgery involves intraoperative risks, postoperative risks and a risk of failure which must be the subject of prior information {Grade A}. Elective caesarean section and systematic episiotomy are not recommended methods of prevention for urinary incontinence {Grade B}. Pelvic floor muscle training is the treatment of first intention for pre- and postnatal urinary incontinence {Grade A}. Prior to any treatment for an elderly woman, it is recommended to screen for urinary infection using a test strip, ask for a bladder diary and measure post-void residual volume {Grade C}. It is recommended to carry out a cough test and look for occult incontinence prior to surgery for pelvic organ prolapse {Grade C}. It is recommended to carry out urodynamic investigations prior to pelvic organ prolapse surgery when there are urinary symptoms or occult urinary incontinence {Grade C}.
尿失禁是女性常见的疾病，可能会导致身体残疾和经济负担{LE1}。在咨询尿失禁时，建议明确说明情况、漏尿的频率和严重程度{等级 B}。咳嗽试验建议在手术前进行{等级 C}。在进行下尿路康复之前，不需要进行尿动力学检查{等级 B}。对于尿失禁手术，建议在手术前进行全面的尿动力学检查{等级 C}。对于单纯性压力性尿失禁，如果临床评估全面（标准化问卷、咳嗽试验、膀胱日记、残余尿量）且结果一致，手术前不需要进行尿动力学检查{PC}。建议对压力性尿失禁患者进行盆底肌肉训练作为治疗方法{等级 C}。对于膀胱过度活动症患者，建议首先进行膀胱训练{等级 C}。对于超重患者，减轻体重可以改善压力性尿失禁{LE1}。对于手术，尿道下吊带（耻骨后或经闭孔途径）是首选的推荐技术{等级 B}。尿道下吊带手术涉及术中风险、术后风险和失败风险，必须事先进行知情告知{等级 A}。选择性剖宫产和系统会阴切开术不是预防尿失禁的推荐方法{等级 B}。盆底肌肉训练是产前和产后尿失禁的首选治疗方法{等级 A}。在对老年女性进行任何治疗之前，建议使用测试条筛查尿路感染，要求患者记录膀胱日记并测量残余尿量{等级 C}。在进行盆腔器官脱垂手术前，建议进行咳嗽试验并寻找隐匿性尿失禁{等级 C}。对于有尿路症状或隐匿性尿失禁的盆腔器官脱垂患者，建议在手术前进行尿动力学检查{等级 C}。
