Management of urinary incontinence in women: summary of updated NICE guidance

[Based on the experience and opinion of the GDG] If the woman wishes to discuss options for further management (non-therapeutic interventions and invasive therapy) refer to multidisciplinary team and arrange urodynamic investigation to determine whether detrusor overactivity is present and responsible for her overactive bladder symptoms: - If detrusor overactivity is present and responsible for the symptoms, offer invasive therapy - If detrusor overactivity is present but the woman does not wish to have invasive therapy, offer advice as described in the section "Women who choose not to have further treatment" - If detrusor overactivity is not present refer back to the multidisciplinary team for further discussion about future management.[Based on high quality evidence from randomised controlled trials including a small number of patients] Discuss the risks and benefits of treatment with botulinum toxin A with women before seeking informed consent, covering - The likelihood of being symptom free or having a large reduction in symptoms - The risk of clean intermittent catheterisation being needed for variable lengths of time after the effect of the injections has worn off - The absence of evidence on duration of effect between treatments and on the long term efficacy and risks - The risk of adverse effects, including an increased risk of urinary tract infection.[Based on the experience and opinion of the GDG] Discuss the long term implications of percutaneous sacral nerve stimulation with women, including: - The need for test stimulation and probability of the test's success - The risk of failure - The long term commitment - The need for surgical revision (for example, if the lead migrates) - The adverse effects (for example, pain at implant site).What are the long term effectiveness, optimal dose, and optimal frequency of repeat therapy of botulinum toxin A in women with overactive bladder based on detrusor overactivity, including risk of adverse events such as urinary infection and intermittent catheterisation?