During a urodynamics study (UDS), there are a variety of pieces of data coming in to the urologist and technician performing the study. Information will be obtained that is both subjective and objective in nature and the question is, who do you believe? Do you believe yourself and the objective data you are reviewing? Or, do you believe what the patient is telling you during the study? This blog post will explore this in detail.
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.
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.
There has been a recent trend on the part of both pharmaceutical and medical device companies to employ nurses and then deploy them in the field in different roles to support their products—the products being drugs and devices, respectively. Given the clinical background and medical knowledge of nurses, this has been a win-win situation for everyone, including the end users of the products, such as patients and healthcare teams and professionals. For medical device companies that have overlooked the trend, it’s something that needs to be given some serious thought since nurse educator services can have a meaningful and lasting impact on medical device utilization rates.
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.
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.
Urodynamic practices should be consistent throughout every medical practice. However, you will find that they often vary depending on clinics, companies, and between countries. This can often lead to procedures being uncomfortable and unnatural for patients, as there isn’t a set standard for explaining or performing the urodynamic testing. The ICS standardization steering committee has wanted to update the international continence society standard for making urodynamic testing consistent across all practices. They aim to add update and improve on testing through the use of reporting from patients after clinical care.
Patient Information & Preparation for Invasive Urodynamics
Before starting any urodynamic treatment, clinicians should prompt patients for past information, physicals, and prepare for the urodynamic treatment.
Urodynamics testing requires very well-trained staff in order to determine the basis and progression of urologic diseases. Typically, UDS training is provided by the equipment manufacturers, but there are other viable training options in the market.
Topics: urodynamics training
Evaluating training course options of any kind can be challenging. There have been entire books and methodologies dedicated to it (see the Kirkpatrick Model for Course Evaluation). We are regularly asked questions related to the urodynamics training (UDS training) we provide and the UDS training provided by others. Typically, UDS training is provided by the equipment manufacturers, but there are other viable training options in the market.