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

Quality statement

Women with overactive bladder or stress urinary incontinence symptoms have a multidisciplinary team review before they are offered 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 multidisciplinary team reviews the treatment options before surgery or other invasive treatment are offered to 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 multidisciplinary team review before they are offered surgery or other invasive treatment.

Numerator – The number in the denominator who had a multidisciplinary team review before they are offered 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 service providers, healthcare professionals, and commissioners

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

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

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

What the quality statement means for patients, service users and carers

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 (NICE guideline CG171), recommendation 1.8.2 (key priority for implementation).

Definitions of terms used in this quality statement

Invasive treatments

  • Intravesical botulinum toxin

  • Percutaneous sacral nerve stimulation

  • Augmentation cystoplasty

  • Urinary diversion

  • Detrusor myectomy

  • Intravesical vanilloid receptor agonists.

[Adapted from urinary incontinence (NICE guideline CG171)]

Multidisciplinary team

The multidisciplinary team for urinary incontinence should include:

  • a urogynaecologist

  • a urologist with a sub‑specialist interest in female urology

  • a specialist nurse

  • a specialist physiotherapist

  • a colorectal surgeon with a sub‑specialist interest in functional bowel problems, for women with coexisting bowel problems

  • a member of the 'care of the elderly team' and/or occupational therapist, for women with functional impairment. [Urinary incontinence (NICE guideline CG171)]