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      Contemporary diagnosis of lower urinary tract dysfunction.

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          Abstract

          Introduction: Diagnosis of lower urinary tract (LUT) dysfunction starts with categorization in clinical syndromes, and initial management is based on the assumptions about pathophysiology that these syndromes contain. However, clinical practice guidelines are ambiguous in clinical specialists’ diagnosis of dysfunction after failure of initial management. This is a narrative and critical review of the existing evidence, and the aim is to suggest practice improvements in the process of clinical specialists’ diagnosis for patients resistant to initial management.

          Methods and Results: Evidence is collated on the basis of the author’s personal preference in combination with good clinical practice general principles. Statements and suggestions to improve reflect personal opinion. For two groups of patients with LUT dysfunction, the strategy of initial diagnosis is summarized and desirable principles of secondary care diagnosis are discussed. More specifically, a structure for the contemporary care of women with signs and symptoms of urinary incontinence is described and for that of the group of men older than 45 years with symptoms of LUT dysfunction.

          Conclusions: Urodynamic testing is the undisputed gold standard for objective assessment and is the only way to stage and grade the dysfunction. Clinical practice guidelines and clinical specialists are too modest about the use and applicability of objective or urodynamic testing for referred persons with LUT dysfunction that is resistant to initial pragmatic management. Objective assessment and diagnosis are mainstays in secondary care, and the indication to perform objective assessments in patients with LUT dysfunction should be advised much more specifically in guidelines and practice recommendations.

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          Most cited references39

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          The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society

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            Urinary Incontinence in Women

            Urinary incontinence, the involuntary loss of urine, is a common health condition that may decrease quality of life. Ten to twenty percent of women and up to 77% of women residing in nursing homes have urinary incontinence, yet only 25% seek or receive treatment.
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              International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study

              The working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard "Good Urodynamic Practice" published in 2002.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Journal
                F1000Res
                F1000Res
                F1000Research
                F1000Research
                F1000 Research Limited (London, UK )
                2046-1402
                9 May 2019
                2019
                : 8
                : F1000 Faculty Rev-644
                Affiliations
                [1 ]Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
                Author notes

                No competing interests were disclosed.

                Author information
                https://orcid.org/0000-0003-0445-4563
                Article
                10.12688/f1000research.16120.1
                6509958
                dd8d9c1d-7f21-44ad-846a-120b7624ee29
                Copyright: © 2019 Rosier P

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 May 2019
                Funding
                The author(s) declared that no grants were involved in supporting this work.
                Categories
                Review
                Articles

                guidelines,diagnosis,urinary incontinence,lower urinary tract dysfunction,lower urinary tract symptoms,luts,oab,bph

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