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.

Prior to performing a TURP, there are several key tests that most urologists employ.

Aside from a history, exam, IPSS score, PSA and urinalysis, most will assess residual urine volume, perform a cystoscopy and measure the prostate – either with a formal TRUS, or based on a CT, MRI or abdominal ultrasound. Urodynamic testing (UDS) is used to varying degrees before a TURP by urologists. On one end of the spectrum there are purists who will only offer a TURP to someone with UDS-proven obstruction;

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.

Urodynamic procedures can be scheduled for reimbursements through Medicare and other insurance companies. You will need to know the exact codes listed below in the article to help build a proper case for calculating how much you can be reimbursed for. The following information is a guide to help you estimate your reimbursement. However, not all reimbursements will be accepted. Contact your insurers for an assessment to check if you qualify for urodynamic procedure reimbursements. Each insurance office has strict policies and guidelines on whether you will get accepted or denied your reimbursement.

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.

In the following article we focus on this study and discuss the effects of the uroselective α1-blocker tamsulosin on urodynamic parameters in male patients with type I primary bladder neck obstruction. Moving forward, an obstruction with high voiding pressure accompanied by poor flow and narrowing at the neck of the bladder with concomitant silent external sphincter on electromyography forms the basis for primary bladder neck obstruction. Alpha blockers, which are used in the treatment of primary bladder neck obstructions do not have evidence for objective urodynamic efficacy.

Let’s delve into the topic. Available treatment options for bladder neck obstruction are observation of the patient with follow-up, clean intermittent catheterization or bladder neck incision, alpha blockers. Studies conducted to assess the efficacy of the pharmacological approach are nonrandomized and small.