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.
My company provides mobile urodynamics, anorectal manometry (ARM), and other diagnostic testing services, serving hundreds of practices and hospitals across the U.S.
We are considered a core service by many of our customers, but we are considered ancillary services by others. We are regularly exposed to the ancillary medical services marketing efforts that practices pursue to attract patients to their ancillary services.
Many marketing efforts are quite successful, while others yield almost no results. Below are a few of the ones we see working consistently.
My company provides advanced diagnostic testing services (primarily urodynamics testing, anorectal manometry testing, and other incontinence related services) to practices all over the country.
Through our work, we are exposed to practices at all profit levels from those that are hugely profitable to those that can barely pay the bills. Based on our work, we have compiled a few ideas below that should help any practice be more profitable. We hope that one or two will hit the mark for you.
The topic of urodynamic studies (UDS) before prolapse surgery is highly debated in urogynecology. There have been previous studies conducted on women who had prolapse and uncomplicated stress urinary incontinence (SUI). Currently, there is no possibility of a universal consensus for UDS before prolapse surgery in women who have concomitant symptomatic SUI. The issue is that there is currently no evidence that the surgery outcome will be altered or not by being given a UDS. Thus, we must test further using randomized studies to advance and see if UDS can be useful before prolapse surgery.
Preoperative UDS Should Be Performed
If a patient with a pelvic organ prolapse (POP) has either stages IIIa, IIc, or lp, she is more likely to have symptomatic vaginal bulging and asymptomatic for stress or urgency incontinence. This case is just one example of where preoperative USD should be performed before the prolapse surgery. It’s been found that POP and lower urinary tract symptoms (LUTS) usually coexist with each other. But, UDS involve objective assessments of any dysfunction in the urinary tract system. Some UDS could prevent and save people from POP. However, not many are willing to perform this option.
Urodynamic services provide valuable information when it comes to the urinary health of patients due to their interaction with medications, drugs, and other substances. However, some clinics doubt that urodynamic services make a difference in specific populations of people. To test this theory Suskind AM, Cox L, and Clemens JQ et al. (2017) decided to test the value of urodynamic services within an academic specialty referral practice. The objective of the study was to demonstrate that UDS services could provide useful information for correct medication doses in patients and other drugs.
Patients & Pre-screening
The perspective questionnaire was designed to determine the use of UDS in clinical practices. Each patient who was invited to be in the study was 18 years or older and were either male or female. Five clinics asked their patients if they wanted to participate in the study if they were coming for a UDS service. They were then prompted with a pre-questionnaire asking their race, gender, age, and if they had previously used UDS services. They were also asked if they had any history of pelvic radiation and neurological conditions.
The storage and elimination of urine are regulated by neural circuits in the brain and spinal cord to coordinate function between the urethra and the urinary bladder. During micturition, the elimination of urine is facilitated by bladder wall contraction as well as urethral wall and pelvic floor muscle relaxation. In the following article, we will discuss discuss this study: Randomized Controlled Trial to Assess the Impact of Intraurethral Lidocaine on Urodynamic Voiding Parameters.
Lower urinary tract symptoms (LUTS) lead to incomplete bladder emptying, decreased quality of life, increased healthcare use, decreased workplace productivity and impact in intimate relationships. Some of the approaches to improve the condition such as
Urodynamics (UDS) is an interactive diagnostic study of lower urinary tract function. It is composed of several tests that can be used to obtain functional information about urine storage and expulsion. Its main goal is to reproduce the patients’ symptoms and determine their cause.
The present article is a review of the physiological concepts behind UDS, and explains the various normal and abnormal forces and parameters that are measured and used during the tests to assist the physician in making a diagnosis. It outlines the importance and methods of the calibration of UDS equipment to optimize diagnostic accuracy and reliability, which would have a crucial impact over the treatment’s decision, and consequently the patient’s outcome.