2019 NICE女性尿失禁和盆腔器官脱垂管理指南(上)

2019 NICE女性尿失禁和盆腔器官脱垂管理指南（上）

导读

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]