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. Many times, urodynamic treatments are invasive; thus, patients end up feeling anxious and uncomfortable. Offices provide patients with leaflets explaining the procedure. However, the terminology is often very vague and complicated for them to understand. There needs to be communication within the healthcare system where patients can get the answers they need both before and during the examination. Future leaflets should include terminology that is easy to understand.
Urodynamic Practice Protocols
Urodynamic testing requires that specific protocols be put into place before the procedure even begins. The issue is that practices and protocols often differ depending on the institution. Therefore, there isn’t a set standard. Here needs to be an implementation of standardized practices to make sure that these programs follow similar steps and produce accurate and consistent results across all patients. Departments need to implement protocols consistent with ICS-GUP standards and coordinate on a nationwide level. This can help with proper accreditation and certification when it comes to urodynamics.
Clinical Practice Pre-testing Information
The next step should be doing pre-testing for urinalysis and physical examinations. This can help evaluate a patient's urinary issues. There needs to be a review of the patient's current medication plan. This can help avoid any issues during urodynamic testing and help clinicians come up with a proper treatment plan. Extra testing such as the patient’s gait, reflexes, and also neurological testing should be performed. For women, there should be a pelvic exam, abdominal exam, and a check of the pelvic muscles, wall masses, contractions, urinary strain, etc. For male patients, they should get rectal and genital examinations along with a prostate exam. Clinicians should instruct patients that they have full control and can change any conservative measures to change medications and treatment before and after testing.
After the pre-testing clinicals should then proceed to uroflowmetry. There are already guidelines on how uroflowmetry must be conducted. ICS has recently updated their equipment and performance requirements, ensuring that there are no issues with the technology. Clinicians should also pay attention to flow rate, voided volume, PVR, and to make sure patients are calm and compliant during this stage. If the patient is not relaxed, the results can be altered. Patients are allowed to change to a comfortable position, but this needs to be reported and documented.
The next step should be conducting a cystometry. This will be used with catheters, pressures, quality checks, and references. There must be a consistent bladder fill rate of 20-30 ml/min. Otherwise, results can vary. Tests have been done, and it has been concluded that patient diuresis can add up to 25% false full measures. Filling rates need to be slowed down and controlled for all aged patients, this way there is no chance of results being altered.
Pressure-Flow Studies & Updates
It’s also suggested that new standards for pressure-flow rates should be recorded and monitored. The new normal voiding function and pressure rise should be within normal limits and should void with an empty bladder.
Technical & Clinical Quality Control
The next change needs to be in quality control. Standardization is critical to urodynamics and the results that they provide patients with. A wrong diagnosis and/or false results could ultimately lead to unnecessary or harmful treatments. There needs to be training for the use of equipment, performance, and regulation of calibrations of pressure equipment. All testing should be recorded and documented during each urodynamic test. When evaluating urodynamics, it’s essential to recognize pressure patterns and to be able to control the pressure continuously. There must be an implementation of urodynamic testing training protocols.
Urodynamic Reports & Results
Lastly, urodynamic testing must be documented with an ICS standard whenever ordered. The documentation must then be followed with ICS-SUT styled reports, and it must be standardized throughout nationwide practices. While it may not be possible to report all data within a urodynamic report, it must be customized to the patient, relevant to the final diagnosis, and should be systematically reported. It’s recommended for practices to also report with a GUP 2002 standard graph which can help present data.
We’ve found that urodynamic practices around the nation often lack when it comes to training, pre-testing, and standardized protocols. There is a great need for standardized implementation across every urodynamic practice. By considering the above-mentioned issues, hopefully, urodynamic practices can be improved upon, and patients will be more likely to use these services without feeling uncomfortable or unprepared.