Urodynamics (UDS) is a relatively safe office procedure; however, as with any invasive procedure or test, there are risks associated with performing UDS. A few simple steps can help avoid complications in the majority of patients. Most of the complications associated with UDS are related to urinary tract infections (UTI) and the majority of this blog will focus on that. Additional complications include pain, patient anxiety and injury from catheter placement.
UTI is the most common serious complication of UDS testing, though the frequency of this is difficult to quantify.1 There are excellent guidelines on this from the University of Michigan1 and the American Urologic Association (AUA) also offers guidance for the prevention of UTI’s associated with UDS.2
The most critical factors in UTI prevention involve appropriate screening of patients for UDS with urinalysis (UA), urine cultures, and evaluation of a prior history of UTI. Patients with a history of UTI should be screened before the UDS procedure with a UA and culture and culture directed antibiotics prophylaxis should be provided once infections have been adequately treated. Anybody with an abnormal UA concerning for a UTI at the time of UDS should have the procedure postponed, the urine cultured and appropriate prophylaxis provided when the UDS is rescheduled.
Whether to provide prophylactic antibiotics routinely to all patients at the time of UDS is beyond the scope of this blog post; however, you should bear in mind that most patients requiring UDS likely meet established criteria for consideration of a single dose of peri-procedural oral antibiotics.
Pain associated with UDS can be due to catheter placement itself, pre-existing issues with the urinary tract, such as irritation from catheters, vaginal atrophy in women and the like. Cautious insertion of catheters, use of lubricating jelly on them and consideration of using a small amount of lidocaine jelly on the catheter are all valuable tools to reduce patient discomfort during UDS.
Nearly all patients have some degree of anxiety about most medical procedures, which is completely normal. UDS is no exception. The test is very unusual, artificial and at its conclusion, a patient is asked to void in front of a complete stranger. No wonder people may be stressed to have UDS testing! The keys to mitigating this are careful description of what is happening during the test, especially some discussion ahead of time with the patient. Allowing the patient to watch the tracings and fluoroscopy images can also be helpful. Additionally, letting patients listen to music on their smartphone and/or playing some gentle background music can also alleviate the fear associated with this test.
Finally, although rare, it is possible to injure the patient or incorrectly place a catheter, especially in the urethra in men. Careful attention to any prior surgical or other history that may suggest issues with placement should be noted. A history of pelvic radiation, pelvic surgery, urethral strictures, benign prostatic hyperplasia or prior difficult catheter placement are all key to elicit and may alert the UDS team that catheter placement may be a challenge.
In sum, careful attention to mitigating the risk of UTI is the most critical aspect pf preventing complications in UDS testing. Allaying patients fears during the test and careful attention to catheter placement are also critical to reducing the risks of this generally safe and well tolerated exam.
References:
- Cameron AP, Campeau L, Brucker BM, et al. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn. 2017;36(4):915–926. doi:10.1002/nau.23253
- Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis [published correction appears in J Urol. 2008 Nov;180(5):2262-3]. J Urol. 2008;179(4):1379–1390. doi:10.1016/j.juro.2008.01.068