[The practice guideline 'Urinary incontinence' (first revision) from the Dutch College of General Practitioners; a response from the perspective of urology]

Abstract

The revised practice guideline 'Urinary incontinence' of the Dutch College of General Practitioners contains some important changes. Urodynamic investigation is not mandatory for differentiating between types of incontinence in the general practice setting. Physical examination including a valsalva leak point test is considered important. From a urological point ofview it remains to be seen whether the history-taking and the physical examination described in the revised guideline will be enough to accurately differentiate between the possible incontinence types. The practice guideline underlines a role for the general practitioner in teaching bladder training or pelvic floor exercises. The benefits of this compared to exercises taught by specialized physiotherapists will have to be determined. Another new feature is that antimuscarinic drugs are mentioned as proper treatment for people suffering from overactive bladder complaints. The practice guideline advises referral of male incontinence patients only if the incontinence is not related to prostate surgery. However, patients with postoperative incontinence should also be referred as there are good diagnostic and therapeutic options available.