Quality statement 7: Multidisciplinary team review before surgery or invasive treatment

Quality statement

Women with overactive bladder or stress urinary incontinence symptoms have a local multidisciplinary team review before surgery or other invasive treatment.

Rationale

Surgery or other invasive treatment should only be considered if conservative management and pharmacological treatment have been unsuccessful. Multidisciplinary team review can ensure that all other possible treatments have been considered before surgery and other invasive treatments. The whole team approach can also help the decision of whether invasive treatment is suitable for the woman.

Quality measures

Structure

Evidence of local arrangements to ensure that a local multidisciplinary team reviews the treatment options before surgery or other invasive treatment for women with overactive bladder or stress urinary incontinence.

Data source: Local data collection.

Process

Proportion of women with overactive bladder or stress urinary incontinence who have a local multidisciplinary team review before surgery or other invasive treatment.

Numerator – The number in the denominator who had a local multidisciplinary team review before surgery or other invasive treatment.

Denominator – The number of women with overactive bladder or stress urinary incontinence who have surgery or other invasive treatment.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as community continence services and hospitals) ensure that local multidisciplinary teams are in place to discuss management strategies before surgery or other invasive treatment for women with overactive bladder or stress urinary incontinence.

Healthcare professionals ensure that women with overactive bladder or stress urinary incontinence have a local multidisciplinary team review before surgery or other invasive treatment.

Commissioners (such as clinical commissioning groups) ensure that they commission services that carry out a local multidisciplinary team review before surgery or other invasive treatment for women with overactive bladder or urinary incontinence.

Women with leakage of urine caused by conditions called overactive bladder or stress urinary incontinence have a review of their condition by a team of healthcare professionals before surgery or other invasive treatment. This review will make sure that all other treatments have been considered and help with the decision of whether invasive treatment is right for the woman.

Source guidance

Urinary incontinence and pelvic organ prolapse in women (2019) NICE guideline NG123, recommendation 1.1.1

Definitions of terms used in this quality statement

Invasive treatments

These include:

  • botulinum toxin type A injection

  • percutaneous sacral nerve stimulation

  • augmentation cystoplasty

  • urinary diversion.

[Adapted from NICE's guideline on urinary incontinence and pelvic prolapse in women]

Local multidisciplinary team

A multidisciplinary team for urinary incontinence that should include:

  • 2 consultants with expertise in managing urinary incontinence in women and/or pelvic organ prolapse

  • a urogynaecology, urology or continence specialist nurse

  • a pelvic floor specialist physiotherapist

and may also include:

  • a member of the care of the elderly team

  • an occupational therapist

  • a colorectal surgeon.

[NICE's guideline on urinary incontinence and pelvic organ prolapse in women]