Since urodynamics (UDS) is a relatively time consuming test, physicians who perform and interpret UDS are reliant on ancillary medical staff to perform much of the UDS study. This role is often performed by a mid-level provider, such as a nurse practitioner (NP), physician’s assistant (PA), registered nurse (RN) and even by a medical assistant or other trained technician (MA). The degree of medical knowledge needed to successfully perform a UDS test does not need to be extensive, hence providers do not need a medical or advanced degree to perform UDS; however, they do need to be proficient in setting the patient up for the test, know the key steps, know how to manage basic artifacts and when to engage the physician during a test.
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.
Core services urologists must offer include basic history and examination ability, cystoscopy and access to and interpretation of relevant lab and/or radiologic studies of the urinary tract. A urologist who cannot offer these basic services is really not practicing urology. UDS is an important test that urologists offer; however, a urology practice can exist without offering UDS and still thrive.
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.
The Great Divide.
There is a great divide that segregates women away from the rest of mainstream medicine. It is a vague dividing line at best, separating what is “down there” from the rest of the female body. Obstetricians and gynecologists have done what they could to obliterate that dividing line by declaring their women’s health specialty a “primary care” specialty. Nevertheless, a vast chasm opens through which many female patients can fall.
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.
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.