- 1.Thorough evaluation of each patient should be performed to determine the underlying etiology of recurrent urinary incontinence and to guide management (II-3B).
- 2.Conservative management options should be used as the first line of therapy (III-C).
- 3.Patients with a hypermobile urethra, without evidence of intrinsic sphincter deficiency, may be managed with a retropubic urethropexy (e.g., Burch procedure) or a sling procedure (e.g., mid-urethral sling, pubovaginal sling) (II-2B).
- 4.Patients with evidence of intrinsic sphincter deficiency may be managed with a sling procedure (e.g., mid-urethral sling, pubovaginal sling) (II-3B).
- 5.In cases of surgical treatment of intrinsic sphincter deficiency, retropubic tension-free vaginal tape should be considered rather than transobturator tape (I-B).
- 6.Patients with significantly decreased urethral mobility may be managed with periurethral bulking injections, a retropubic sling procedure, use of an artificial sphincter, urinary diversion, or chronic catheterization (III-C).
- 7.Overactive bladder should be treated using medical and/or behavioural therapy (II-2B).
- 8.Urinary frequency with moderate elevation of post-void residual volume may be managed with conservative measures such as drugs to relax the urethral sphincter, timed toileting, and double voiding. Intermittent self-catheterization may also be used (III-C).
- 9.Complete inability to void with or without overflow incontinence may be managed by intermittent self-catheterization or urethrolysis (III-C).
- 10.Fistulae should be managed by an experienced physician (III-C).
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This clinical practice guideline has been prepared by the Urogynaecology Committee and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.