BERKELEY, CA (UroToday.com) - The 4th Consultation on Incontinence was held in Paris in July 2008. The structure of the consultation followed the successful formula developed by the ICUD and used for the previous 3 consultations. Once again an international faculty of over 150 individuals from a wide range of professions and specialities were grouped into a series of subcommittees, each with a specific area of responsibility. The spectrum of subcommittees spanned from Basic Science through assessment and investigation to therapy. These committees were further divided into specific patient groups for children, women, men, neurological patients and the frail elderly. In addition to fully integrating faecal incontinence and pelvic organ prolapse into the consultation, there was the renamed committee “Bladder Pain Syndrome”.

Subcommittee members were selected according to their academic reputation giving due recognition to the need to provide balance between specialities and geographical regions. A chairperson was selected for each subcommittee and was responsible for the drafting of that committees’chapter. Most committees met at least once before the consultation in Paris, to progress their report.

Each chairperson presented his or her committees’main discussions and recommendations in Paris. Their chapter was then modified accordingly, in the light of the consultation. This book details the evidence reviewed by each committee. Each committee used the ICUD System for evaluating evidence and providing recommendations with five levels of evidence (1 to 5) and four grades of recommendation (A to D).

This system worked well for the treatment committees but, as yet, it cannot be applied systematically to evaluate the evidence from the basic science and investigation committees. Nevertheless, the consultation feels that continued efforts to specify the evidence base for all recommendations are of vital importance.

The book’s final chapter is comprised of the Recommendations of the International Scientific Committee which includes all subcommittee chairs together with the members of the Steering Committee. This chapter has been expanded to include algorithms for the treatment of faecal incontinence, pelvic organ prolapse and bladder pain syndrome. Furthermore, the 2004 algorithms have been reconfigured in the light of new evidence and in order to facilitate their use. These recommendations represent the evidence based opinion of a group of experts. They are not to be considered as guidelines or standards of care which are the responsibility of official organisations, governments and regulators.

A tremendous amount of effort went into the consultation and the production of the accompanying book - a publication that will undoubtedly increase awareness of all aspects of the consultation’s findings.

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