2019年4月，英国国家卫生与临床优化研究所（NICE）发布了女性尿失禁和盆腔器官脱垂的管理指南，主要内容涵盖了年龄≥18岁女性尿失禁和盆腔器官脱垂的评估和管理，同时也包含相关手术并发症的管理。本指南内容分两次报道，现为第一部分，主要内容为尿失禁的评估、一般治疗以及药物选择。


尿失禁分类


At the initial clinical assessment, categorise the woman's urinary incontinence as stress urinary incontinence, mixed urinary incontinence or urgency urinary incontinence/overactive bladder. Start initial treatment on this basis. In mixed urinary incontinence, direct treatment towards the predominant symptom.[2006]


在最初的临床评估中，将女性尿失禁分为压力性尿失禁、混合性尿失禁或急迫性尿失禁/膀胱过度活动症。在此基础上开始初步治疗。在混合性尿失禁中，直接治疗主要症状。（2006）


尿失禁的评估


If women have symptoms of urinary tract infection (UTI) and their urine tests positive for both leucocytes and nitrites, send a midstream urine specimen for culture and analysis of antibiotic sensitivities. Prescribe an appropriate course of antibiotic treatment pending culture results. See the NICE guideline on urinary tract infection (lower): antimicrobial prescribing for more information. [2006, amended 2019]


如果女性有泌尿道感染（UTI）症状，且尿白细胞和亚硝酸盐检测阳性，则应送一份中段尿培养并分析抗生素敏感性。根据培养结果开具合适的抗生素处方。有关更多信息，请参阅NICE尿路感染指南（下）：抗菌药物处方。（2006，2019年修订）


If women do not have symptoms of UTI, but their urine tests positive for both leucocytes and nitrites, do not offer antibiotics without the results of midstream urine culture. [2006]


如果女性没有UTI症状，但尿白细胞和亚硝酸盐检测阳性，在没有中段尿培养结果的情况下，则不提供抗生素治疗。（2006）


If a woman does not have symptoms of UTI and her urine tests negative for either leucocytes or nitrites, do not send a urine sample for culture because she is unlikely to have UTI. [2006]


如果女性没有UTI症状，且尿白细胞或亚硝酸盐检测阴性，则不必送尿培养，因其不太可能患有UTI。（2006）


Follow the recommendations on referral for urinary tract cancer in the NICE guideline on suspected cancer, for women with haematuria or recurrent or persistent unexplained UTI. [2006, amended 2019]


对于有血尿、复发性或持续性不明原因UTI的女性，请遵循NICE可疑肿瘤指南中关于泌尿系肿瘤治疗的建议。（2006，2019年修订）


尿失禁的一般治疗


Consider advising women with urinary incontinence or overactive bladder and a high or low fluid intake to modify their fluid intake. [2006]


建议尿失禁或膀胱过度活跃，以及液体摄入量高或低的女性调整液体摄入量。（2006）


Advise women with urinary incontinence or overactive bladder who have a BMI greater than 30 to lose weight. [2006]


建议BMI指数大于30的尿失禁或膀胱过度活跃女性减肥。（2006）


Offer a trial of supervised pelvic floor muscle training of at least 3 months' duration as first-line treatment to women with stress or mixed urinary incontinence. [2019]


一线治疗：为压力性或混合性尿失禁女性提供至少3个月的盆底肌训练。（2019）


Pelvic floor muscle training programmes should comprise at least 8 contractions performed 3 times per day. [2006]


盆底肌训练每次应至少8个收缩轮回，每天3次。（2006）


Electrical stimulation and/or biofeedback should be considered for women who cannot actively contract pelvic floor muscles to aid motivation and adherence to therapy. [2006]


对于不能主动收缩盆底肌肉以帮助锻炼和坚持治疗的女性，应考虑电刺激和/或生物反馈。（2006）


Offer bladder training lasting for a minimum of 6 weeks as first-line treatment to women with urgency or mixed urinary incontinence. [2006]


一线治疗：为急迫性或混合性尿失禁女性提供至少6周的膀胱训练。（2006）


If women do not achieve satisfactory benefit from bladder training programmes, the combination of an overactive bladder medicine with bladder training should be considered if frequency is a troublesome symptom. [2006]


如果女性不能从膀胱训练中获得令人满意的益处，在尿失禁频繁的情况下，应考虑结合使用药物和膀胱训练。（2006）


Bladder catheterisation (intermittent or indwelling urethral or suprapubic)  should be considered for women in whom persistent urinary retention is  causing incontinence, symptomatic infections or renal dysfunction, and in whom  this cannot otherwise be corrected. Healthcare professionals should be aware,  and explain to women, that the use of indwelling catheters in urgency urinary  incontinence may not result in continence. [2006]


对于持续性尿潴留导致尿失禁、症状性感染或肾功能不全，且无法纠正的女性，应考虑膀胱导尿（间歇性、留置或耻骨上导尿）。（2006）


药物选择


Do not offer women flavoxate, propantheline or imipramine to treat urinary incontinence or overactive bladder. [2013]


不建议女性服用黄酮哌酯、丙氨酸或丙咪嗪以治疗尿失禁或膀胱过度活动症。（2013）


Do not offer oxybutynin (immediate release) to older women who may be at higher risk of a sudden deterioration in their physical or mental health. [2013, amended 2019]


不建议年龄较大女性服用奥昔布宁（立即释放），这些女性身心健康突然恶化的风险可能更高。（2013，2019年修订）


Offer the anticholinergic medicine with the lowest acquisition cost to treat overactive bladder or mixed urinary incontinence in women. [2019]


以最低购置成本提供抗胆碱能药物治疗女性膀胱过度活动症或混合性尿失禁。（2019）


Offer a transdermal overactive bladder treatment to women unable to tolerate oral medicines. [2013]


为不能耐受口服药物的女性提供经皮膀胱过度活动症治疗。（2013）


The use of desmopressin may be considered specifically to reduce nocturia in women with urinary incontinence or overactive bladder who find it a troublesome symptom. Use particular caution in women with cystic fibrosis and avoid in those over 65 years with cardiovascular disease or hypertension. [2013]


对于严重尿失禁或膀胱过度活动症的女性，可特别考虑使用去氨加压素用于减少夜尿症。囊胞性纤维症女性要特别谨慎使用，65岁以上有心血管疾病或高血压者忌服。（2013）


Do not use duloxetine as a first-line treatment for women with predominant stress urinary incontinence. Do not routinely offer duloxetine as a second-line treatment for women with stress urinary incontinence, although it may be offered as second-line therapy if women prefer pharmacological to surgical treatment or are not suitable for surgical treatment. If duloxetine is prescribed, counsel women about its adverse effects. [2006]


不建议主要有压力性尿失禁的女性使用度洛西汀作为一线治疗。对于压力性尿失禁女性，不建议常规提供度洛西汀作为二线治疗，但如果患者更喜欢药物或手术治疗，或者不适合手术治疗，可作为二线治疗。如果使用度洛西汀，请告知女性副作用。（2006）


Do not offer systemic hormone replacement therapy to treat urinary incontinence. [2006]


不建议使用全身激素替代疗法治疗尿失禁。（2006）


Offer intravaginal oestrogens to treat overactive bladder symptoms in postmenopausal women with vaginal atrophy. [2006]


建议阴道内雌激素疗法治疗绝经后阴道萎缩女性的膀胱过度活动症。（2006）


医脉通编译整理自：

https://www.nice.org.uk/guidance/ng123/chapter/Recommendations