International Consultation On Incontinence Research Articles

QUALITY OF LIFE OF PATIENTS WITH STRESS URINARY INCONTINENCE TREATED WITH TWO SURGICAL METHODS: A RANDOMIZED CONTROLLED STUDY

Introduction: Static or stress urinary incontinence unquestionably in women has a significant negative impact on quality of life. Surgical treatment is the standard way of treating women with static stress incontinence, if the desired effect is not achieved with a conservative method of treatment. Objectives: To compare the quality of life of a group of patients with stress urinary incontinence surgically treated with Hammock method with the group treated by Needle method, and to compare the results with the quality of life of a healthy population of women. Methods: The study used the recommended questionnaire from the International Consultation on Incontinence, a short questionnaire ICIQ- SF. This questionnaire was used to collect data on symptomatology, frequency, amount of urine, and the impact on the quality of life before and after surgical treatment. Results: A statistically significant difference (p<0.05) in improving the quality of life of patients operated on needle method was found, significantly higher after surgery. It was also found that there was a statistically significant difference (p<0.05) in improving the quality of life and in patients operated on by the Hammock method. Patients who underwent Needle surgery reported a better quality of life after surgery, compared to patients who underwent Hammock surgery. No statistically significant difference (p>0.05) was found between the postoperative quality of life of patients operated on the Needle method and people without incontinence difficulties. Conclusion: The results of the research have shown that the Needle method is more effective in improving the quality of life of patients with stress urinary incontinence 6 months after surgery. Keywords: stress incontinence, quality of life, surgical methods

Effects of Pilates and Conventional Treatment Methods in The Management of Stress Urinary Incontinence Among Women

Stress Urinary Incontinence is a common condition among women that requires attention. The main aim of thisstudy was to compare the effects of Pilates and conventional treatment methods in managing stress urinary incontinence amongwomen. This study is an experimental design, comparative pre-post-test type. 30 female subjects with stress urinaryincontinence were randomly divided into groups, Group A and Group B, with 15 subjects in each group. Group A receivedPilates exercises, and Group B subjects received conventional Kegel's exercises. The study duration was 12 weeks. The pad test,cough stress test, and International Consultation on Incontinence (ICIQ) Questionnaire were outcome measures. The results ofthis study revealed that on comparing the Mean values of Group A & Group B on the International Consultation onIncontinence Questionnaire (ICIQ) and Pad test, Group A (Pilates Exercise) showed 4.46 and 4.93 post-test values which weremore effective than Group B (Conventional kegel's Exercise) at 8.60 and 9.46 at P ≤ 0.001. The Pilates group experienced ahighly significant improvement on the cough stress test compared to the conventional group at P< 0. 001.Pilates exercises wereproven highly effective in managing stress urinary incontinence among women. This study is one of its kind, which demonstratedthe effect of Pilates and its clinical usage for the effective management of Stress Urinary Incontinence.

Research priorities for diagnostic instrumentation in urinary incontinence.

The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.

Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse.

(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance.

Pelvic floor distress inventory (PFDI)-systematic review of measurement properties.

The Pelvic Floor Distress Inventory (PFDI) and PFDI-20 have been translated and validated into several languages ​​with different measurement property values ​​and are recommended by the International Consultation on Incontinence (ICI) as grade A for assessing pelvic floor dysfunction. Thus, the aim of the current study was to investigate the measurement properties of the PFDI and PFDI-20. Systematic review conducted in August 2020 through a search performed in PubMed, SCOPUS, WoS, ScienceDirect, CINAHL, and Google Scholar for studies that evaluated the measurement properties of the PFDI and PFDI-20. The data were analyzed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Initially, 2857 studies were found, and 7 studies on PFDI and 25 on PFDI-20 were analyzed. The PFDI presented high quality of evidence for hypothesis testing, moderate for test-retest reliability and responsiveness, and very low quality of evidence for content validity. The PFDI-20 presented high quality of evidence for criterion validity, hypothesis testing, and responsiveness, moderate quality for test-retest reliability and measurement errors, and very low quality of evidence for content validity. It was not possible to rate the quality of evidence of the internal consistency of the PFDI and PFDI-20. No studies assessed the cross-cultural validity. Only the hypothesis testing presented high quality of evidence for the PFDI. Criterion validity, hypothesis testing, and responsiveness presented a high quality of evidence for the PFDI-20. Due to the high degree of recommendation of the PFDI and PFDI-20 given by the ICI, further studies are needed to reevaluate all the measurement properties of these instruments.

Development of a flowchart reflecting the current attitude and approach towards idiopathic overactive bladder treatment in Belgium: A Delphi study.

Idiopathic overactive bladder syndrome (iOAB) is a prevalent condition in urological practice. The variability in management between specialists and between centers remains high. Even existing guidelines contain inconsistencies. We aimed to develop a treatment algorithm for iOAB for use in daily clinical practice. From October 2018 till November 2019, a Delphi study was conducted to obtain expert consensus on the management of iOAB. Members from the Belgian Working Group of Functional Urology were asked to rate online statements, based on gaps and variabilities between the American Urology Association (AUA), European Association of Urology (EAU) and International Consultation on Incontinence (ICI) guidelines on iOAB. The consensus was reached if ≥75% of the panel agreed on the level of appropriateness. Two Delphi rounds and an open discussion session were held. Twenty out of 49 members completed the first round and 18 completed the second round. The consensus was reached on 44/143 statements and 15/56 statements in the first and second round, respectively. The consensus was reached on criteria by which to phenotype OAB patients, the terminology relating to the first-, second- and third-line treatment, the duration of therapies, the chronological order, and the choice between therapies. No consensus was reached on the role of percutaneous tibial nerve stimulation (PTNS) in the treatment algorithm. A flowchart reflecting the current attitude and approach of a Delphi expert panel towards the treatment of iOAB was developed. We propose its use in daily clinical practice to increase the standardization of OAB treatment.

Physiotherapy assessment for female urinary incontinence

Introduction and hypothesisAs noted in the 6th International Consultation on Incontinence (ICI) chapter “Initial Management of Urinary Incontinence in Women” recommendations call for including physiotherapy as a first-line therapy.MethodsBuilding on this, checking available scientific evidence and using the International Classification of Functioning, Disabilities and Health, the following represents a holistic physiotherapist approach for initial evaluation of the health problem of urinary incontinence.ResultsThis paper proposes a teaching module for every relevant health care professional dealing with the assessment of adult female urinary incontinence, focusing on optimal patient selection and appropriate treatment choice.ConclusionThe assessment stage involves the explicit decision as to whether “physiotherapy” is the treatment indicated for the patient, based on the findings of the physiotherapy assessment and supplemented by any medical information that accompanied the referral and evaluation.

Surgery for female SUI: The ICI algorithm.

Stress urinary incontinence (SUI) is common in women and can significantly impact quality of life. This is a review of the 6th International Consultation on Incontinence (ICI) chapter analyzing level of evidence on surgical treatment of SUI as well as the consensus algorithm that resulted from the detailed work in the committee report as of April 2017. Included studies in this review were selected to highlight the algorithm for management. Non-operative and surgical treatment options exist; conservative therapies comprise first line management, but if SUI remains bothersome, surgical treatment should be considered. Bulking agents offer a minimally invasive option with moderate short-term success rates. The most commonly performed surgical treatments for SUI are mid-urethral and pubovaginal slings, with high cure rates and patient satisfaction. Retropubic suspension is a more traditional but widely accepted procedure. Single incision sling, adjustable sling, or artificial urinary sphincter may be appropriate in carefully selected patients. The choice of surgical procedure should be made only after a thorough discussion and shared decision between the patient and surgeon regarding risks, benefits, and alternatives. A trial of conservative therapy should be conducted where relevant. Referral to a specialist should be considered in women with a more complex presentation.

Surgery for urinary incontinence in women: Report from the 6th international consultation on incontinence.

Urinary incontinence is a prevalent condition worldwide and causes a tremendous impact on a woman's quality of life. While conservative and non-surgical therapies are options for treatment, surgery for stress urinary incontinence (SUI) is common. Options include colposuspension, slings (pubovaginal and midurethral), and periurethral bulking. While evidence supports each of these options in the treatment of SUI, each is associated with various rates of success and unique adverse event profiles. Urgency urinary incontinence (UUI) is initially treated with behavioral modification and pharmacologic means, with surgery reserved for those with refractory symptoms or significant complications from medication use. At present, intravesical onabotulinumtoxinA injections, percutaneous tibial nerve stimulation, and sacral neurostimulation are all viable options for refractory UUI/overactive bladder. As with surgical interventions for SUI, each of these is, likewise, associated with unique outcomes and adverse event profiles. Herein, we summarize the findings and conclusions from the 6th International Consultation on Incontinence (ICI) regarding surgical treatment of urinary incontinence in women.

Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International Consultation on Incontinence.

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on the definition of moderate SUI. Injectable agents have a poor success rate in men with SUI. Options for recurrent SUI due to urethral atrophy after AUS implantation include changing the pressure balloon, downsizing the cuff and increasing the amount of fluid in the system. Infection and/or erosion demand surgical removal or revision of all or part of the prosthesis. Although there are several series reporting the outcomes of different surgical interventions for PPUI, there is still a need for prospective randomized clinical trials. Recommendations for future research include standardized workup and outcome measures, and complete reporting of adverse events at long-term.

Effect of Postpartum Pelvic Floor Muscles Training in Pelvic Floor Muscles Strength on Postpartum Women with Stress Urinary Incontinence

Objective: To evaluate the effect of pelvic floor training (Kegelexercise) on pelvic floor muscle strength in postpartum womenwith SUI.Methods: Thirty-five birth vaginally postpartum women with SUIwere experimentally enrolled. After four weeks of postpartumobservation, the diagnosis of SUI confirmed, and all of these womenwere asked to complete the International Consultation onIncontinence Questionnaire-Sort Form (ICIQ-SF) questionnaire.The strength of the pelvic floor muscle measured with perineometerevery once in 3 weeks for 12 weeks of Kegel exercise. SUI severityassessed with ICIQ-SF after completing the Kegel exercise. A pairedt-test was used to compare measurement results between ICIQ-SFquestionnaire and perineometer and multiple linear regressionmodels was used for multivariate analysis. A p value of less than 0.05was taken to be statistically significant.Results: Findings show a significant difference between clinicalvariables (parity, neonates birth weight, perineal tear grade, BMI)and the improvement of pelvic floor muscles before and afterperformed the Kegel exercise (all p<0.05). The pelvic floormuscles strength significantly improved (p=0.000) after Kegelexercise both in ICIQ-SF questionnaire and perineometermeasurement.Conclusion: Pelvic muscles floor training or Kegel exercise improvepelvic muscles floor strength in postpartum women with SUI.[Indones J Obstet Gynecol 2018; 6-2: 114-118]Keywords: pelvic muscles floor training, postpartum, stress urinaryincontinence

Safety and Efficacy of Intermittent versus Continuous Anticholinergic Medication in Management of Overactive Bladder in Adult

Background: overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient's quality of life. It is widely accepted that diet and life style modifications, behavioral therapy and medication belong to the standard conservative therapeutic options and considered as the first-line measures. The International Consultation on Incontinence (ICI) guidelines reported that when the first line approach is not fully satisfactory or fails after 8-12 weeks, alternative therapies should be sought out. It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line of therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation, detrusor injections with botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments. Objective: this study aimed to compare between the efficacy of continuous anticholinergic therapy and intermitted anticholinergic therapy for treatment of the overactive bladder. Patients and Methods: our study included 60 patients categorized into two groups: continuous anticholinergic therapy group and intermitted anticholinergic therapy. By using 12 weekly intermitted anticholinergic therapies, remarkable clinical results were obtained. Percent of the patients who complained OAB in the intermitted anticholinergic group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response. Results: patients in the intermitted anticholinergic therapy group showed significant improvement of frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (53%) compared to propiverine group frequency (50%) urgency (60%) urge incontinence (67%) and nocturia (67%). No serious side effects were reported, in group A 8 patients had horm of dry mouth in 5 cases (16.7%), constipation in 2 cases (67%) 8 blurred vision in one case (33%). In group B, there were 5 patients (16.7%) in the horm of dry mouth in 3 cases (10% constipation in one case (3.3) and blurred vision in one case (3.3%). Conclusion: our study concluded that intermittent anticholinergic therapy induced improvement of bladder over activity symptoms and less side effects than continuous anticholinergic group.

II．国際失禁会議（ICI）の便失禁診療ガイドライン

便失禁の適切な診断・治療には，ガイドラインなどによる診療の標準化が重要で，それは国際標準に準拠した高い信頼性が求められる．国際失禁会議（International Consultation on Incontinence，ICI）は，尿・便失禁に関する国際的なコンセンサスミーティングで，1998年以来3～4年に1度開催されている．本邦独自の便失禁診療ガイドライン作成に際して，ICIのガイドラインを参考にするのは有意義であり，本稿では2012年にパリで開催された第5回ICIによる最新の便失禁診療ガイドラインを紹介する．しかし前回会議から既に3年が経過し，新たなエビデンスによって推奨度を変更すべき検査や治療法もある．最近，米国結腸直腸外科学会（ASCRS）が最新のエビデンスに基づいた便失禁に対する診療ガイドラインを発表したので，ICIによる推奨度に加えてASCRSによる推奨度も併記する．

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence.

The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Revision and updates of the 4th ICI Report using systematic review covering years 2008-2012. Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a "grade of recommendation." The paper concludes with areas identified as requiring further research. For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation. Neurourol. Urodynam. 35:15-20, 2016. © 2014 Wiley Periodicals, Inc.

Where to for pelvic organ prolapse treatment after the FDA pronouncements? Reply to Pelikan

Dear Editor, We thank Dr. Pelikan [1] for his interest and comments regarding our review article on the treatment of pelvic organ prolapse (POP) after the US Food and Drug Administration (FDA) pronouncements [2]. The author rightly observes that the study by Maher et al. [3] does not support the statement that abdominal sacral colpopexy (ASC) is more effective than vaginal sacrospinous colpopexy (VSC). Indeed, in their randomized controlled trial (RCT) study comparing ASC and VSC, they conclude that both procedures are highly effective for treating vaginal vault prolapse. There were no differences in subjective and objective success rates between the two groups after 2 years follow-up. The International Consultation on Incontinence (ICI) committee reviewed surgery for POP [4] and identified three RCTs designed to compare vaginal and abdominal routes for surgical correction, including Maher et al.’s study [3]. The results are summarized in a Cochrane review byMaher et al. [5] in which they state that these trials provide level I evidence that the overall outcome (including quality of life) is similar between abdominal and vaginal approaches but that sacrospinousbased vaginal procedures have higher anterior and apical anatomical and dyspareunia recurrence rates than ASC. This is somewhat offset by the higher short-term morbidity of open abdominal sacrocolpopexy [4]. Therefore we should have referred to reference 10 instead of reference 14 in our manuscript to support the statement of higher apical success of ASC. A recently published study by Nygaard et al. on the longterm (7 years) outcomes following ASC for POP, with or without Burch urethropexy, reported increasing failure rates after 7 years, which emphazises the need for RCTs with longterm follow-up [6].

Use of patient reported outcome questionnaires in the urogynecologic literature

We aimed to describe the current use of patient reported outcome questionnaires (PROQ) in the urogynecologic literature. All articles from 2009 in 11 journals were reviewed and included if PROQ were used. PROQ were assigned the grades of recommendation used by the International Consultation on Incontinence (ICI). Data were collected by two independent reviewers (differences resolved by consensus). Fisher and χ(2) tests were used for statistics. Of the 212 articles included, 126 used multiple PROQ. Seventy-two percent used at least one grade A PROQ and 42% exclusively used grade A PROQ. Articles about urinary incontinence (UI) were more likely to use grade A PROQ than those pertaining to interstitial cystitis or anal incontinence. Eighty-three articles used PROQ in non-English languages. These articles were as likely to use ICI grade A PROQ as those using English PROQ. When translated questionnaires are used, 41.5% of articles did not provide references for a validation of the translated version. Eighty-seven different PROQ were identified and used 422 times. Of those, 75 were developed in English. Short versions were used more frequently. PROQ available online were used 9.4 times more frequently than those requiring payment. The more utilized PROQ were more often grade A than those rarely used (P < 0.001). Using multiple PROQ is common in the literature reviewed. 72.2% of articles used at least one PROQ with the highest ICI recommendation but only 42% used exclusively those. Short and easily available PROQ were used more often. Most PROQ are developed in English.

EAU guidelines on urinary incontinence

ContextThe first European Association of Urology (EAU) guidelines on incontinence were published in 2001. These guidelines were periodically updated in the past years. ObjectiveThe aim of this paper is to present a summary of the 2009 update of the EAU guidelines on urinary incontinence (UI). Evidence acquisitionThe EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly. Evidence summaryA full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depend on severity and/or complexity of symptoms and clinical signs and are different for men, women, frail older persons, children, and patients with neuropathy. At the level of initial management, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe), more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery. ConclusionsTreatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective.

Guías EAU sobre incontinencia urinaria

Context The first European Association of Urology (EAU) guidelines on incontinence were published in 2001. These guidelines were periodically updated in past years. Objective The aim of this paper is to present a summary of the 2009 update of the EAU guidelines on urinary incontinence (UI). Evidence acquisition The EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly. Evidence summary A full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depends on severity and/or complexity of symptoms and clinical signs and is different for men, women, frail older persons, children, and patients with neuropathy. At the level of initial management, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe),more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery. Conclusions Treatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective.

Patient reported outcomes: The ICIQ and the state of the art

Following the first International Consultation on Incontinence (ICI) in 1998, a multidisciplinary committee was established to develop a universally applicable, brief urinary incontinence patient-reported outcome (PRO) questionnaire: the ICIQ-UI Short Form. The project was expanded to recommend and develop high quality, validated questionnaires for all lower pelvic dysfunction related to incontinence. The ICI Modular Questionnaire project (ICIQ) was then established to include a wider spectrum of urinary, bowel and vaginal symptoms and their impact on health related quality of life (HRQL). Three aims underpin the ICIQ project: To recommend high quality, validated PRO questionnaires. To promote wider use of questionnaires to standardize assessment of lower pelvic dysfunction and its impact on HRQL. To facilitate communication in different patient settings and patient groups. The authors, both ICIQ committee members, debated the title. If the conceptualization of the ICIQ is correct, the PROs recommended by the ICIQ need to be under constant evolution and improvement to ensure the aims of the ICIQ project. A modular questionnaire design, recognized and implemented internationally, would add greatly to the universal inclusion, interpretation and understanding of PRO data in clinical practice and clinical research. However, in order to achieve the goals of the ICIQ project, we must ensure that the scientific quality of PRO development, documentation and validation meets current scientific standards, as well as societal and governmental regulatory guidelines. These topics are discussed along with recommendations for future areas of research and need for the ICIQ committee to explore these issues.

Pharmacological treatment of overactive bladder: report from the International Consultation on Incontinence

Treatment options for the overactive bladder were recently discussed at the 4th International Consultation on Incontinence (ICI) held in Paris, 5-8 July 2008. This article will overview current thoughts on the pharmacological and clinical basis for the different classes of drugs currently used for the treatment of lower urinary tract symptoms/overactive bladder syndrome/and detrusor overactivity. Individual drugs are not discussed in detail; particular consideration is given to therapeutic aspects of the management of the elderly patient. An extensive literature review confirms the rationale for using antimuscarinic drugs, and that the currently used drugs are efficacius with an acceptable tolerability and safety. In patients resistant to antimuscarinics, botulinum toxin may be an alternative--the vanilloids resiniferatoxin and capsaicin have very limited use. New therapeutic options with positive proof-of-concept studies, but with limited clinical experience, are beta3 adrenoceptor agonists and phosphodiesterase type 5 inhibitors. Positive signals have been found for other classes of drugs (e.g., gonadotropin-releasing hormone antagonists, neurokinin receptor-1 antagonists), but available information is not sufficient for proper assessment. Antimuscarinic drugs remain the first-line treatment of the overactive bladder and a favorable efficacy/tolerability-safety ratio can be confirmed. Promising new alternatives are emerging and future controlled studies will decide their place in the therapeutic arsenal.