2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association


  • Mathieu Bettez Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC
  • Le Mai Tu
  • Kevin Carlson Department of Surgery, Division of Urology, University of Calgary, Calgary, AB
  • Jacques Corcos Department of Surgery, Division of Urology, McGill University, Montreal, QC
  • Jerzy Gajewski Department of Urology, Dalhousie University, Halifax, NS
  • Martine Jolivet Department of Surgery, Division of Urology, Université de Montréal, Montreal, QC
  • Greg Bailly Department of Urology, Dalhousie University, Halifax, NS




Adult urinary incontinence (UI) is a highly prevalentcondition, and one which can have a major impacton patients’ quality of life. It is also a major focus ofa urologist’s workload. As a result, the Canadian UrologicalAssociation (CUA), with the aid of its Guidelines Committee,commissioned the development of a practice guideline documentin 2005 first authored by Dr. Jacques Corcos. As perthe CUA Guidelines Committee’s mandate, all guidelinesare subject to revision after 5 years.


Download data is not yet available.

Author Biography

Mathieu Bettez, Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC

Department of Surgery, Division of Urology, Université de Sherbrooke, Sherbrooke, QC


The Canadian continence foundation. Incontinence: A Canadian perspective; 2007. http://www.canadiancontinence.

ca/pdf/Research_paper_August2007.pdf (Accessed September 10, 2012).

Abrams P, Andersson KE, Birder L, et al. Fourth International Consultation on Incontinence Recommendations

of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ

prolapse, and fecal incontinence. Neurourol Urodyn 2010;29:213-40. http://dx.doi.org/10.1002/


Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/

International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.

Neurourol Urodyn 2010;29:4-20.

Herschorn S, Gajewski J, Schulz J, et al. A population-based study of urinary symptoms and incontinence:

the Canadian Urinary Bladder Survey. BJU Int 2008;101:52-8.

Lee JY, Kim HW, Lee SJ, et al. Comparison of doxazosin with or without tolterodine in men with symptomatic

bladder outlet obstruction and an overactive bladder. BJU Int 2004;94:817-20. http://dx.doi.


Welk BK, Herschorn S. The male sling for post-prostatectomy urinary incontinence: a review of contemporary

sling designs and outcomes. BJU Int 2012;109:328-44. http://dx.doi.org/10.1111/j.1464-

X.2010.10502.x. Epub 2011 Oct 17.

Herschorn S, Bruschini H, Comiter C, et al. Surgical treatment of stress incontinence in men. Neurourol

Urodyn 2010;29:179-90. http://dx.doi.org/10.1002/nau.20844

Porena M, Mearini E, Mearini L, et al. Voiding dysfunction after radical retropubic prostatectomy: more

than external urethral sphincter deficiency. Eur Urol 2007;52:38-45. http://dx.doi.org/10.1016/j.


Bauer RM, Gozzi C, Hubner W, et al. Contemporary management of postprostatectomy incontinence. Eur

Urol 2011;59:985-96. http://dx.doi.org/10.1016/j.eururo.2011.03.020

Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy:

a systematic review and cumulative analysis of comparative studies. Eur Urol 2009;55:1037-63. http://


Bauer RM, Bastian PJ, Gozzi C, et al. Postprostatectomy incontinence: all about diagnosis and management.

Eur Urol 2009;55:322-33. http://dx.doi.org/10.1016/j.eururo.2008.10.029

The Canadian Agency for Drugs and Technologies in Health. http://www.cadth.ca (Accessed September

, 2012).

Offermans MP, Du Moulin MF, Hamers JP, et al. Prevalence of urinary incontinence and associated risk

factors in nursing home residents: a systematic review. Neurourol Urodyn 2009;28:288-94. http://


DuBeau CE. Beyond the bladder: management of urinary incontinence in older women. Clin Obstet Gynecol

;50:720-34. http://dx.doi.org/10.1097/GRF.0b013e3180d0a4e7

DuBeau CE, Kuchel GA, Johnson T 2nd, et al. Incontinence in the frail elderly: report from the 4th

International Consultation on Incontinence. Neurourol Urodyn 2010;29:165-78. http://dx.doi.


Goode PS, Burgio KL, Richter HE, et al. Incontinence in older women. Jama 2010;303:2172-81. http://


Resnick NM, Yalla SV. Detrusor hyperactivity with impaired contractile function. An unrecognized but common

cause of incontinence in elderly patients. JAMA 1987;257:3076-81. http://dx.doi.org/10.1001/


Ghoniem G, Stanford E, Kenton K, et al. Evaluation and outcome measures in the treatment of female

urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and

clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:5-33. http://dx.doi.org/10.1007/


Fritel X, Fauconnier A, Bader G, et al. Diagnosis and management of adult female stress urinary incontinence:

guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur

J Obstet Gynecol Reprod Biol 2010;151:14-9. http://dx.doi.org/10.1016/j.ejogrb.2010.02.041

Thuroff JW, Abrams P, Andersson KE, et al. EAU guidelines on urinary incontinence. Eur Urol 2011;59:387-


Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, et al. What type of urinary incontinence does this woman

have? JAMA 2008;299:1446-56. http://dx.doi.org/10.1001/jama.299.12.1446

Amir B, Farrell SA. SOGC Committee opinion on urodynamics testing. J Obstet Gynaecol Can 2008;30:717-27.

Azzouzi AR, Ballereau C, Desgranchamps F, et al. [Management of male urinary incontinence after radical

prostatectomy (CTMH AFU 2006-1/5): incidence and role of urodynamic assessment and electromyography].

Prog Urol 2008;18:14-8. http://dx.doi.org/10.1016/j.purol.2007.10.009

Gibbs CF, Johnson TM 2nd, Ouslander JG. Office management of geriatric urinary incontinence. Am J Med

;120:211-20. http://dx.doi.org/10.1016/j.amjmed.2006.03.044

Resnick NM. An 89-year-old woman with urinary incontinence. JAMA 1996;276:1832-40. http://dx.doi.


Nygaard I. Clinical practice. Idiopathic urgency urinary incontinence. N Engl J Med 2010;363:1156-62.


Smith AL, Wein AJ. Urinary incontinence: pharmacotherapy options. Ann Med 2011;43:461-76. http://


Kay G, Crook T, Rekeda L, et al. Differential effects of the antimuscarinic agents darifenacin and oxybutynin

ER on memory in older subjects. Eur Urol 2006;50:317-26. http://dx.doi.org/10.1016/j.


Cardozo L. Systematic review of overactive bladder therapy in females. Can Urol Assoc J 2011;5:S139-42.


Wagg AS, Cardozo L, Chapple C, et al. Overactive bladder syndrome in older people. BJU Int 2007;99:502-


Tyagi P, Tyagi V, Chancellor M. Mirabegron: a safety review. Expert Opin Drug Saf 2011;10:287-94.


Cartwright R, Renganathan A, Cardozo L. Current management of overactive bladder. Curr Opin Obstet

Gynecol 2008;20:489-95. http://dx.doi.org/10.1097/GCO.0b013e32830fe38c

Rovner E, Kennelly M, Schulte-Baukloh H, et al. Urodynamic results and clinical outcomes with intradetrusor

injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic

overactive bladder. Neurourol Urodyn 2011;30:556-62. http://dx.doi.org/10.1002/nau.21021

Smith CP. Botox(R) in urology--will it become standard of care for urge urinary incontinence? J Urol

;184:2235-6. http://dx.doi.org/10.1016/j.juro.2010.09.050

Apostolidis A. Neuromodulation for intractable OAB. Neurourol Urodyn 2011;30:766-70. http://dx.doi.


Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive

bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol 2010;184:2416-


Rickey LM, Kenton K. Botulinum toxin: new option for refractory lower urinary tract symptoms in women.

Clin Obstet Gynecol 2008;51:176-86. http://dx.doi.org/10.1097/GRF.0b013e3181621fd2

Al-zahrani AA, Elzayat EA, Gajewski JB. Long-term outcome and surgical interventions after sacral neuromodulation

implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol 2011;185:981-6.


Yamanishi T, Kamai T, Yoshida K. Neuromodulation for the treatment of urinary incontinence. Int J Urol

;15:665-72. http://dx.doi.org/10.1111/j.1442-2042.2008.02080.x

Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding

dysfunction in adults. Cochrane Database Syst Rev 2009:CD004202.

Ridout AE, Yoong W. Tibial nerve stimulation for overactive bladder syndrome unresponsive to medical

therapy. J Obstet Gynaecol 2010;30:111-4. http://dx.doi.org/10.3109/01443610903428922

Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation

versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J

Urol 2010;183:1438-43. http://dx.doi.org/10.1016/j.juro.2009.12.036

Occhino JA, Siegel SW. Sacral nerve modulation in overactive bladder. Curr Urol Rep 2010;11:348-52.


Chapple C. Systematic review of therapy for men with overactive bladder. Can Urol Assoc J 2011;5:S143-5.


Athanasopoulos A, Chapple C, Fowler C, et al. The role of antimuscarinics in the management of men

with symptoms of overactive bladder associated with concomitant bladder outlet obstruction: an update.

Eur Urol 2011;60:94-105. http://dx.doi.org/10.1016/j.eururo.2011.03.054

Ng CK, Gonzalez RR, Te AE. Refractory overactive bladder in men: update on novel therapies. Curr Urol

Rep 2006;7:456-61. http://dx.doi.org/10.1007/s11934-006-0054-5

Herschorn S, Pommerville P, Stothers L, et al. Tolerability of solifenacin and oxybutynin immediate release

in older (> 65 years) and younger (= 65 years) patients with overactive bladder: sub - analysis from

a Canadian, randomized, double-blind study. Curr Med Res Opin 2011;27:375-82. http://dx.doi.org/


Taylor JA 3rd, Kuchel GA. Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed

geriatric condition. J Am Geriatr Soc 2006;54:1920-32. http://dx.doi.org/10.1111/j.1532-


Shamliyan TA, Kane RL, Wyman J, et al. Systematic review: randomized, controlled trials of nonsurgical

treatments for urinary incontinence in women. Ann Intern Med 2008;148:459-73.

Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments,

for urinary incontinence in women. Cochrane Database Syst Rev 2010:CD005654.

Nager CW, Richter HE, Nygaard I, et al. Incontinence pessaries: size, POPQ measures, and successful

fitting. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:1023-8. http://dx.doi.org/10.1007/s00192-


Richter HE, Burgio KL, Brubaker L, et al. Continence pessary compared with behavioral therapy or combined

therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 2010;115:609-17. http://


Lapitan MC, Cody JD, Grant A. Open retropubic colposuspension for urinary incontinence in women.

Cochrane Database Syst Rev 2009:CD002912.

Guerrero KL, Emery SJ, Wareham K, et al. A randomised controlled trial comparing TVT, Pelvicol and

autologous fascial slings for the treatment of stress urinary incontinence in women. BJOG 2010;117:1493-


Albo ME, Richter HE, Brubaker L, et al. Burch colposuspension versus fascial sling to reduce urinary

stress incontinence. N Engl J Med 2007;356:2143-55. http://dx.doi.org/10.1056/NEJMoa070416

Richter HE, Albo ME, Zyczynski HM, et al. Retropubic versus transobturator midurethral slings for stress

incontinence. N Engl J Med 2010;362:2066-76. http://dx.doi.org/10.1056/NEJMoa0912658

Novara G, Artibani W, Barber MD, et al. Updated systematic review and meta-analysis of the comparative

data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment

of female stress urinary incontinence. Eur Urol 2010;58:218-38. http://dx.doi.org/10.1016/j.


Ross S, Robert M, Swaby C, et al. Transobturator tape compared with tension-free vaginal tape for

stress incontinence: a randomized controlled trial. Obstet Gynecol 2009;114:1287-94. http://dx.doi.


Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA guideline on the surgical management

of female stress urinary incontinence. J Urol 2010;183:1906-14. http://dx.doi.org/10.1016/j.


Walsh CA. TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months. BJU

Int 2011;108:652-7.

Giri SK, Hickey JP, Sil D, et al. The long-term results of pubovaginal sling surgery using acellular crosslinked

porcine dermis in the treatment of urodynamic stress incontinence. J Urol 2006;175:1788-92;

discussion 93.

Cerruto MA, Artibani W. Transobturator versus retropubic synthetic slings: comparative efficacy and safety.

Curr Opin Urol 2011;21:275-80. http://dx.doi.org/10.1097/MOU.0b013e3283476edb

Lapitan MC, Cody JD, Grant A. Open retropubic colposuspension for urinary incontinence in women: a short

version Cochrane review. Neurourol Urodyn 2009;28:472-80. http://dx.doi.org/10.1002/nau.20780

Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence

after radical prostatectomy: a randomised controlled study. Eur Urol 2010;57:1039-43. http://dx.doi.


CUAJ • October 2012 • Volume 6, Issue 5 363

Canadian Urological Association Scholarship Fund (CUASF)


CUASF was established in 1973 as a means of supporting promising Canadian urologic researchers and therefore to

facilitate Canadian Urology research productivity. This early career award plays a vital role within our organization,

enabling young clinical researcher to get their foot in the door with respect to peer-reviewed support and financial backing at a critical

point in their careers. This past year we had some outstanding young investigators apply for the CUASF and the committee has

awarded 4 new scholarships:

• Matthew Eric Hyndman – University of Calgary

NMR based Metabolomic Assessment of Prostate cancer

• Girish S. Kulkarni – University of Toronto

Avoidance in Patients At Risk For Prostate Cancer and in Patients With Low Risk Prostate Cancer: Developing Tools for

Personalized Medicine

• Nicholas E. Power – University of Western Ontario

The Prognostic Role of Fractal Geometry in Renal Cell Carcinoma

• Frank Papanikolaou – Credit Valley Hospital

Community award

A Study to Identify the Prevalence of, Risk Factors for, and Effect of Alternative Anti-microbial Administration in Patients

who Carry Ciprofloxin Resistant Enteric Organisms in a Population of Patients Undergoing Transrectal Biopsy of Prostate

We are also very pleased to highlight the recent collaboration with Astellas Pharma Canada and the CUASF in developing a CUAAstellas

Research Grant. This program, separate from the CUASF scholarship awards, was developed to support peer-reviewed

research that promotes excellence in Urology research with the ultimate goal of improving patient care. See page 352 for 2013

Grant information. The recipients of this Grant are:

• Ben Chew – University of British Columbia

Signaling Hedgehog Pathway and Ureteral Peristalsis and Stents

• Blaine Welk – University of Western Ontario

The Development and Validation of a Neurogenic Bladder Symptom Score for Use in Clinical Study

• Alexandre Zlotta – University of Toronto

A Non-Invasive Epigenetic Urinary Biomarker Panel for the Early Detection of Bladder Cancer



CUA Guideline: Urinary incontinence

Burgio KL, Goode PS, Urban DA, et al. Preoperative biofeedback assisted behavioral training to decrease

post-prostatectomy incontinence: a randomized, controlled trial. J Urol 2006;175:196-201. http://


Goode PS, Burgio KL, Johnson TM 2nd, et al. Behavioral therapy with or without biofeedback and pelvic

floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial.

JAMA 2011;305:151-9. http://dx.doi.org/10.1001/jama.2010.1972

Welk BK, Herschorn S. Are male slings for post-prostatectomy incontinence a valid option? Curr Opin Urol

;20:465-70. http://dx.doi.org/10.1097/MOU.0b013e32833ecd09

Saussine C, Azzouzi AR, Ballereau C, et al. [Management of male urinary incontinence after radical

prostatectomy (CTMH AFU 2006-3/5): place of periurethral balloon and suburethral tape]. Prog Urol

;18:23-8. http://dx.doi.org/10.1016/j.purol.2007.10.010

Khullar V, Cardozo L, Dmochowski R. Mixed incontinence: current evidence and future perspectives.

Neurourol Urodyn 2010;29:618-22. http://dx.doi.org/10.1002/nau.20907

Sajadi KP, Vasavada SP. Overactive bladder after sling surgery. Curr Urol Rep 2010;11:366-71. http://


Murray S, Lemack GE. Overactive bladder and mixed incontinence. Curr Urol Rep 2010;11:385-92.


Katsumi HK, Rutman MP. Can we predict if overactive bladder symptoms will resolve after sling surgery in

women with mixed urinary incontinence? Curr Urol Rep 2010;11:328-37. http://dx.doi.org/10.1007/


Fonda D, Abrams P. Cure sometimes, help always--a “continence paradigm” for all ages and conditions.

Neurourol Urodyn 2006;25:290-2. http://dx.doi.org/10.1002/nau.20187

Campeau L, Tu LM, Lemieux MC, et al. A multicenter, prospective, randomized clinical trial comparing

tension-free vaginal tape surgery and no treatment for the management of stress urinary incontinence in

elderly women. Neurourol Urodyn 2007;26:990-4. http://dx.doi.org/10.1002/nau.20440




How to Cite

Bettez, M., Tu, L. M., Carlson, K., Corcos, J., Gajewski, J., Jolivet, M., & Bailly, G. (2012). 2012 Update: Guidelines for Adult Urinary Incontinence Collaborative Consensus Document for the Canadian Urological Association. Canadian Urological Association Journal, 6(5). https://doi.org/10.5489/cuaj.10



CUA Guideline