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NICE to recommend wider range of first-line treatments for urinary incontinence

Draft NICE guidelines for urinary incontinence recommend a wider range of antimuscarinic drugs for use first-line in urinary incontinence.

The draft guidelines released for consultation this week say that women with overactive bladder syndrome or mixed urinary incontinence should be offered a choice of oxybutynin, tolterodine or propiverine (immediate release) as a first-line treatment.

Current NICE guidelines, dating from 2006, recommended only oxybutynin as first-line treatment, with other antimuscarinics for use as second-line treatments if oxybutynin was not well tolerated.

The new guidelines say that extended-release formulations of trospium, oxybutynin or tolterodine may be offered as second line treatments, as well as darifenacin.

However, women should not be offered solifenacin, propiverine (extended release) fesoterodine and trospium (immediate release), and oxybutynin (immediate release) should not be offered to frail women.

Dr Julian Spinks, a GP in Rochester and a member of the development panel for the current guidelines told Pulse that the new recommendations reflect a re-evaluation of cost effectiveness of antimuscarinic drugs.

He said: ‘This reflects that we’re several years on in experience from the previous guideline and there’s much more information known about [treatments].

‘The basic outline of how to treat has not really changed from the previous guidelines. The overall thrust is still to start with lifestyle modification, pelvic muscle floor training  for urge incontinence and managing overactive bladder with bladder retraining.

‘Then there’s a step-up to using drugs for overactive bladder and step-up to possibly using tape procedures for urinary incontinence,” he said

If antimuscarinic treatment is not successful, the guidelines recommend that women should be reviewed by a multidisciplinary team before being offered treatments such as bladder wall injection with botulinum toxin A or sacral nerve stimulation.

Percutaneous posterior tibial nerve stimulation should not be offered routinely for overactive bladder and should only be considered if antimuscarinic drug treatment has not worked adequately  and women.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: ‘This draft updated clinical guideline suggests a range of treatments that women should be able to access to limit the distress that urinary incontinence can cause. These new recommendations will, when published, sit alongside the original 2006 guideline to provide women with high quality up–to-date care and support.’