UDS is a critical procedure in the practice of urology and the management of voiding dysfunction in men and women. All urologists receive exposure to UDS testing during residency training. In the United States, residents are required to perform and interpret 10 UDS studies in order to graduate from residency. In addition, some residents choose to undertake fellowship training in Female Pelvic Medicine and Reconstructive Surgery (FPMRS), where substantial exposure to UDS is had. UDS testing certainly is utilized in significantly more patients and a part of care for many other patients encounter during training; however, as with many other skills, there will be a wide range of exposure during training and quality will certainly vary between programs.
As with many of the practical aspects of urodynamics (UDS) testing, the rate at which the bladder is filled during the cystometric portion of the exam influences the test results. Generally speaking, filling during UDS can be at rates below physiologic levels, at physiologic levels or at supra-physiologic levels. There are distinct pros and cons to filling at either physiologic rates or rates above that, while filling at a rate below the natural rate of bladder filling is both inefficient and unnatural.
As with many aspects of medical practice, a solid training foundation is critical to best practices and the safe delivery of care. When it comes to performing urodynamics (UDS), as with many other procedures, the question of what level of training is requisite to perform UDS appropriately is a reasonable one. And the natural extension of this is whether or not a specific certification process is warranted to perform UDS.
Urodynamics (UDS) testing is a critical tool for the urologist managing voiding dysfunction and incontinence.
Like all tests, there are certain scenarios where the results are more helpful than others and times when using a test is critical.
This blog posts explores several key situations when UDS is a critical test to consider.
This video covers:
- General Overview
- Status Lights
- Buttons used for troubleshooting
- Changing the battery
National listing of the largest urogynecology practices operating within the U.S.
Urogynecology practices across the U.S. have changed considerably over the last decade. Many practices have merged and increased in size in order to be more competitive and deal the complexities of insurance, Medicare, and Medicaid reimbursements. Additionally, these practices have starting taking on more diagnostic and treatment services that were traditionally done in hospital settings. These services include minor surgeries, CT scans, urodynamics testing, and more. A listing of the largest urogynecology practices in the U.S. is provided below:
Proper quality control before and during urodynamics (UDS) is critical to obtaining optimal test results. There are several key maneuvers that should be performed before the study begins and in the event of issues during the test, several remedial actions that can be taken. The International Continence Society (ICS) has previously published on quality control during UDS and the work of both Blaivas and Abrams has expanded our understanding of both quality control and artifacts (Abrams, 2012). The reader should review the excellent manuscript from Abrams for further details, as much of this blog post refers to these works.
After radical prostatectomy (RP), nearly 5-10% of men may experience substantial issues with urine control. Immediately after surgery many men have issues, especially with stress leakage; however, most will regain an acceptable level of continence within 6-12 months of surgery. For this smaller group of men with persistent incontinence, however, urine control can be a substantial issue and some require additional intervention to restore continence. Urodynamics can be a helpful adjunct in this population.
One of the most vexing clinical situations happens to be one of the best uses of urodynamics (UDS): ongoing symptoms after female incontinence surgery. These cases are challenging and patients are often not happy to have ongoing symptoms, new symptoms or worsening symptoms; however, appropriately utilized and interpreted, UDS can be key to helping these patients.
Surgical management of stress urinary incontinence (SUI) is a commonplace procedure, usually indicated on the basis of the clinical history and exam findings alone. In fact, Level I evidence from the VALUE trial suggests that urodynamics (UDS) makes no difference in the outcome of SUI surgery in straightforward cases.1 Nonetheless, in many situations UDS is a critical part of evaluating SUI patients for surgery; moreover, in some instances UDS will spare women surgery that may not be beneficial.2
One clear-cut area where UDS is very helpful is for the patient who has previously undergone surgery for SUI and/or pelvic organ prolapse (POP). These patients may present complex anatomy, obstruction from prior surgery, changes in bladder compliance, and a very high valsalva leak point pressure. UDS may help guide the decision as to what intervention(s) may be necessary in these patients.