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    2019年4月，英國國家衛(wèi)生與臨床優(yōu)化研究所（NICE）發(fā)布了女性尿失禁和盆腔器官脫垂的管理指南，主要內(nèi)容涵蓋了年齡≥18歲女性尿失禁和盆腔器官脫垂的評估和管理，同時也包含相關(guān)手術(shù)并發(fā)癥的管理。本指南內(nèi)容分兩次報道，現(xiàn)為第一部分，主要內(nèi)容為尿失禁的評估、一般治療以及藥物選擇。

一．尿失禁的分類

   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]

    在最初的臨床評估中，將女性尿失禁分為壓力性尿失禁、混合性尿失禁或急迫性尿失禁/膀胱過度活動癥。在此基礎(chǔ)上開始初步治療。在混合性尿失禁中，直接治療主要癥狀。（2006）

二．尿失禁的評估

1.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）癥狀，且尿白細(xì)胞和亞硝酸鹽檢測陽性，則應(yīng)送一份中段尿培養(yǎng)并分析抗生素敏感性。根據(jù)培養(yǎng)結(jié)果開具合適的抗生素處方。有關(guān)更多信息，請參閱NICE尿路感染指南（下）：抗菌藥物處方。（2006，2019年修訂）

2.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]

    如果女性沒有UTI癥狀，但尿白細(xì)胞和亞硝酸鹽檢測陽性，在沒有中段尿培養(yǎng)結(jié)果的情況下，則不提供抗生素治療。（2006）

3.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]

    如果女性沒有UTI癥狀，且尿白細(xì)胞或亞硝酸鹽檢測陰性，則不必送尿培養(yǎng)，因其不太可能患有UTI。（2006）

4.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]

   對于有血尿、復(fù)發(fā)性或持續(xù)性不明原因UTI的女性，請遵循NICE可疑腫瘤指南中關(guān)于泌尿系腫瘤治療的建議。（2006，2019年修訂）

三．尿失禁的一般治療

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

    建議尿失禁或膀胱過度活躍，以及液體攝入量高或低的女性調(diào)整液體攝入量。（2006）

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

    建議BMI指數(shù)大于30的尿失禁或膀胱過度活躍女性減肥。（2006）

3.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]

    一線治療：為壓力性或混合性尿失禁女性提供至少3個月的盆底肌訓(xùn)練。（2019）

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

    盆底肌訓(xùn)練每次應(yīng)至少8個收縮輪回，每天3次。（2006）

5.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]

    對于不能主動收縮盆底肌肉以幫助鍛煉和堅持治療的女性，應(yīng)考慮電刺激和/或生物反饋。（2006）

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

    一線治療：為急迫性或混合性尿失禁女性提供至少6周的膀胱訓(xùn)練。（2006）

7.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]

    如果女性不能從膀胱訓(xùn)練中獲得令人滿意的益處，在尿失禁頻繁的情況下，應(yīng)考慮結(jié)合使用藥物和膀胱訓(xùn)練。（2006）

8.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]

    對于持續(xù)性尿潴留導(dǎo)致尿失禁、癥狀性感染或腎功能不全，且無法糾正的女性，應(yīng)考慮膀胱導(dǎo)尿（間歇性、留置或恥骨上導(dǎo)尿）。（2006）

四．藥物選擇

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

    不建議女性服用黃酮哌酯、丙氨酸或丙咪嗪以治療尿失禁或膀胱過度活動癥。（2013）

2.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]

   不建議年齡較大女性服用奧昔布寧（立即釋放），這些女性身心健康突然惡化的風(fēng)險可能更高。（2013，2019年修訂）

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

   以最低購置成本提供抗膽堿能藥物治療女性膀胱過度活動癥或混合性尿失禁。（2019）

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

   為不能耐受口服藥物的女性提供經(jīng)皮膀胱過度活動癥治療。（2013）

5.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]

   對于嚴(yán)重尿失禁或膀胱過度活動癥的女性，可特別考慮使用去氨加壓素用于減少夜尿癥。囊胞性纖維癥女性要特別謹(jǐn)慎使用，65歲以上有心血管疾病或高血壓者忌服。（2013）

6.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]