Clinical Guidelines for Female Lower Urinary Tract Symptoms

Generally Female Lower Urinary Tract Symptoms are linked with sexual function, pregnancy, delivery, and pelvic organ prolapse.

The researchers selected women above 18 years of age with some lower urinary tract symptoms. The patients who may require nursing care has a different pathology and is thus not included. These guidelines have been specially made for urologists and other health professionals who are involved in the treatment of female patients with a broad range of Lower Urinary Tract Symptoms, and contain two algorithms for "primary treatment" and "specialized treatment", respectively.

The clinical guidelines mainly contain two algorithms for "primary treatment" and "specialized treatment," respectively. There are total 6 chapters that address 26 clinical questions including:

(i) treatment algorithms

(ii) what are female lower urinary tract symptoms

(iii) epidemiology and quality of life

(iv) pathology and illness

(v) diagnosis

(vi) treatment.

The articles were collected using a variety of sources like the PubMed and MEDLINE mostly from 2011 to 2018 also few were articles before 2011 and after 2018 were used as needed.

The grade of recommendation was determined to reflect the discussion and agreement of committee members upon close examination of the consistency of the conclusion, effect size, applicability, and treatment characteristics, such as adverse reactions and cost, for the level of evidence drawn from the articles. (The level of the article (I to V) was determined for articles about treatment.)

Grade Description

A	This action is strongly recommended
B	This action is recommended
C	There is no clear evidence for recommending this action
C1	Performing the action is not recommended
C2	Not performing this action is recommended
D	The action can still be performed
Pending	No decision has been made regarding the grade of recommendation

Following this, there were certain therapeutic methods assigned for the above-grade recommendations.

Therapeutic method	Grade of recommendation
Lifestyle interventions
Weight loss	A
Exercise	C1
Cessation of smoking	C1
Diet (fluid consumption) intervention	C1
Management of constipation	C1
Pelvic floor muscle training	A
Bladder training/Scheduled voiding regimens	B
Miscellaneous
Vaginal cone	C1
Acupuncture	C1
Thermal sheet	C1 (not yet approved)
Hypnotherapy	Pending (not yet approved)

To summarize the clinical guidelines, when the women's symptoms majorly involve voiding and post‐micturition symptoms, specific treatment modality is advised. In case of voiding symptoms simultaneous with storage symptoms, residual urine should be measured; if the residual urine volume is less than 100 ml, then the priority should be given for diagnosis and treatment for storage symptoms, and if the volume is equal to or greater than 100 ml, then specialized treatment should be considered.

When storage symptoms are the primary condition, then the patient should be subjected to the primary treatment algorithm. While specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation.

Surgical treatment is recommended for stress urinary incontinence.

Lastly, surgery may benefit pelvic organ prolapse, a type of mechanical lower urinary tract obstruction.

For more information refer to:

"Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition)" by Takahashi S published in the International Journal of Urology

https://doi.org/10.1111/iju.14492