Are Urologists Properly Trained in Urodynamics (UDS) During Training?

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.

It is unclear what the learning curve is for mastery of UDS testing. Clearly exposure to a small number of cases is not sufficient for mastery, as this has been demonstrated in a variety of surgical and medical scenarios. The concept of a learning curve is applied to surgical training and represents the minimum number of cases a surgeon needs to have sufficient competence with a procedure that the risk of complications diminishes and operative outcomes and case times improve. There is every reason to assume UDS has a learning curve; however, a search of PubMed for “learning curve” and “urodynamics” yields no obvious papers with those terms in the title to answer to this question.

When case logs from graduating US Urology residents are assessed, the most recent available data from graduates in 2018 shows an average number of UDS cases logged was 28.5, +/- 30. The median number was 18 and impressively the range is 9-209. When examining the two years before, the range in 2017 was 3-445 and in 2016 was 0-322! Clearly there exists a wide disparity in experience with UDS during residency and the graduate with hundreds of cases is likely a master and with greater skill than many practicing urologists, while someone not even meeting the 10-case minimum may not have even basic competence.

Given that the published literature does not provide much guidance on this topic, it is difficult to make a blanket statement as to whether UDS training during residency is or isn’t adequate. Furthermore, given that there is no readily known learning curve for training in UDS, we must assume the 10-case minimum suggested by the ACGME is a floor for competence and not indicative of mastery. As with many other skills learned during residency, there appears to be a very wide range of experience and thus mastery associated with UDS during urology residency and a summary statement as to whether training is adequate across the board cannot be made. As with many skills in urology, some residents will be better prepared than others out of training to perform an interpret UDS.