Incontinence 4th Edition 2009
Foreword
The First International Consultation on Incontinence held in 1998 highlighted the plight of some 200 millions sufferers from urinary incontinence worldwide. Urinary incontinence represents a particular and severe problem in certain developing areas of the world, where labour and birth injuries lead to catastrophic leakage. Untreated vesico-vaginal fistula (VVF), particularly in sub Saharan Africa, affects millions of women causing ostracism from society. Because of the enormity of this particular problem, at the second consultation we added a specific
committee to highlight the subject, to advance the understanding of the causes of birth injury, to lead to improved treatment for the many untreated women, and most importantly, to begin preventative programmes. At this Fourth Consultation we were delighted by the active participation of the WHO in our work on VVF.
There were two other new committees in the 2nd ICI: Pelvic Organ Prolapse and Faecal Incontinence. The first consultation stressed the importance of a multidisciplinary approach to continence care, and the new committees on pelvic organ prolapse and faecal incontinence recognize that, particularly in women, urinary incontinence coexists with prolapse and faecal incontinence in many instances. This is also true, to a more limited extent, in men with coexisting faecal incontinence. The task of these two committees was very
considerable and they had to outline the basic science, and investigation and management techniques within
a single chapter. The report of these two chapters laid the foundation for a broadening of the multidisciplinary approach to pelvic disorders which was further developed in the 3rd ICI and now in the 4th ICI. New patterns by which care is delivered are emerging and depend on the close collaboration between urologists, gynaecologists and coloproctologists, working within a multidisciplinary team with nurses and physiotherapists. From the research and investigation point of view, we are very dependent on our colleagues from other disciplines such as the basic sciences, epidemiology, social science and engineering.
The 4th Consultation on Incontinence was held in Paris in July 2008. In this consultation we gave a special
attention the VV fistula in the developing world in collaboration with the WHO and many other associations
working in this field. The structure of the consultation followed the successful formula developed by the ICUD
and used for the previous 3 consultations. Once again an international faculty of over 150 individuals from a
wide range of professions and specialities were grouped into a series of subcommittees, each with a specific
area of responsibility. The spectrum of subcommittees spanned from Basic Science through assessment and
investigation to therapy. These committees were further divided into specific patient groups for children, women,men, neurological patients and the frail elderly. In addition to fully integrating faecal incontinence and pelvic organ prolapse into the consultation, there was the renamed committee “Bladder Pain Syndrome”.
Subcommittee members were selected according to their academic reputation giving due recognition to the
need to provide balance between specialities and geographical regions. A chairperson was selected for each
subcommittee and was responsible for the drafting of that committees’ chapter. Most committees met at least once before the consultation in Paris, to progress their report.
Each chairperson presented his or her committees’ main discussions and recommendations in Paris. Their chapter was then modified accordingly, in the light of the consultation. This book details the evidence reviewed by each committee. Each committee used the ICUD System for evaluating evidence and providing recommendations with five levels of evidence (1 to 5) and four grades of recommendation (A to D).
This system worked well for the treatment committees but, as yet, it cannot be applied systematically to
evaluate the evidence from the basic science and investigation committees. Nevertheless, the consultation feels that continued efforts to specify the evidence base for all recommendations are of vital importance.
The book’s final chapter is the Recommendations of the International Scientific Committee which includes all
subcommittee chairs together with the members of the Steering Committee. This chapter has been expanded
to include algorithms for the treatment of faecal incontinence, pelvic organ prolapse and bladder pain syndrome. Furthermore, the 2004 algorithms have been reconfigured in the light of new evidence and in order to facilitate their use.
These recommendations represent the evidence based opinion of a group of experts. They are not to be
considered as guidelines or standards of care which are the responsibility of official organisations, governments and regulators.
We hope that the huge amount of effort put into the consultation and the production of this book will also be
reflected in an increased prominence for all aspects of the consultation’s findings. We shall make the book more widely available and publish sections of the book in peer reviewed journals.
The Editors
Paul Abrams, Linda Cardozo, Saad Khoury, Alan Wein
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