Recently, a large-scale study of men referred to urologists in England for difficulty urinating has published results (Lewis Eur Urol 2019). This trial, called UPSTREAM, recruited over 800 men for two dozen locations across England. In addition to the usual history, physical and baseline evaluation for the voiding issues, some men were randomized to undergoing a urodynamics test (UDS) and the authors have recently reported some of their data.
One of the key findings is that men, especially those likely to undergo prostate surgery for voiding dysfunction, report very high rates of nocturia (urinating at night) and difficulty with erections (Lewis, 2019). Additionally, older men suffered from leakage of urine, nocturia and issues with erections, while younger men tended to report frequent urination during the day as a complaint (Lewis 2019). Furthermore, men that underwent UDS during the study tended to be satisfied with the test.
The authors performed additional, in depth interviews of patients who had UDS testing (Selman, Neurourol Urodyn 2019). These interviews were structured and they involved a total of 41 men. Of these men, 16 had never had UDS testing before and 25 had prior UDS testing. Of the novices, they were willing to undergo the test, but had some questions and anxiety about UDS testing. Of men who had previously undergone UDS testing, they all were satisfied with the test itself, but sometimes felt pain during the test, some developed a urinary tract infection from the test, and others reported feeling ashamed or embarrassed during the test (Selman). Overall, these men felt the UDS test added valuable data into the evaluation of their voiding issues.
These interviews provided some additional insight into how to best prepare men for UDS testing, how to transmit results and how to minimize embarrassment during the test (Selman 2019). It is critical to discuss the test in detail with men before conducting it, maintain good communication during the test and be sure to honor men’s privacy. Likewise, communicating the role of the test in the overall treatment scheme, discuss the results in a thorough and transparent manner and answer questions about the test is key. Finally, maintaining privacy during the test is another area where men reported strong feelings.
Providers who perform UDS can glean much from the UPSTREAM trial, specifically the work of Selman and colleagues. It is clear that communication before and after UDS, along with minimizing patient embarrassment are critical factors to a successful UDS test and experience for the patient.