Canadian Urological Association guidelines on urinary incontinence.
Bibliographic record
Abstract
OBJECTIVE: To develop the first Canadian guidelines for the management of adult urinary incontinence (UI). METHOD: Following a mandate of the Canadian Urological Association, six Canadian urologists collaborated to produce these guidelines after having extensively reviewed existing foreign guidelines and literature from 1966 to June 2005. RESULTS: The terminology proposed by the standardization committee of the International Continence Society (ICS) is recommended. Basic evaluation must include a history, physical examination, evaluation of post void residual volume, urinalysis and voiding diary. A more detailed evaluation is recommended for complex cases or if initial management fails. As non-pharmacological treatments, devices (catheters, pessaries, etc...) play an important role in selected patients. Lifestyle adjustments are recommended to be implemented first before considering other forms of treatment. Pelvic exercises can be helpful for the mildest cases of pelvic relaxation, in motivated compliant patients. In highly selected patients neuromodulation can improve the patient's quality of life. Probantheline, oxybutinin and tolterodine have a proven efficacy in the treatment of UI. Imipramine and oestrogens are suggested while flavoxate has an unproven efficacy. Surgery in women is indicated when the degree of incontinence is sufficiently troublesome to the patient, the incontinence has been observed by the examiner, its causes adequately evaluated and conservative therapies have been reviewed. Primary stress urinary incontinence in the female is effectively treated by a retropubic suspension (Burch or Marshall- Marchetti-Krantz), or a pubovaginal sling procedure. Pubovaginal slings are the procedure of choice in the presence of significant intrinsic sphincteric deficiency (ISD), the absence of hypermobility, or in the treatment following a failed retropubic suspension. Peri urethral injectables are recommended first line treatment of SUI when available. In men, artificial sphincter is the treatment of choice in neurogenic and non-neurogenic SUI. In neurogenic bladders and sometimes in non neurogenic bladders other forms of surgeries such as bladder denervation, bladder augmentations, neurostimulation, urinary diversion can be considered as the treatment of choice for individual patients. CONCLUSION: Canadian guidelines on incontinence have been completed in 2005 reflecting the Canadian health environment. This field of UI is in constant progression and, when of proven efficacy, new medications and devices have to be included in the proposed algorithm of care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.042 | 0.014 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".