Independent Review Urodynamics

Scouring papers and finding independent reviews of the tests utilized in a urodynamic study (including UroCuff), benefitshelps to answer several questions: How is a patient’s outcome influenced by a urodynamic study? Is incontinence improved directly or indirectly? What kind of treatment options are most readily used in treating incontinence? Does a urodynamic study actually influence clinical decision making?

Urodynamic studies include tests such as uroflowmetry, filling cystometry, pressure-flow studies, post void residual measurement, electromyography, as well as leak point pressure management. The tests are performed to diagnose problems associated with urine leakage, frequent urination, painful urination, sudden and long urges to urinate, problems starting a urine stream, problems emptying the bladder completely, as well as recurrent urinary tract infections. As most of you are aware, there can be some preparation required by the patient for the tests, usually making sure a patient is hydrated so a study of the lower urinary tract can be performed.

The tests are performed because of an underlying problem or problems and are not intended to directly treat lower urinary tract pathology. As with any test, the results are to help influence treatment for a better patient outcome. As seen in the paper, “Urodynamic studies for management of urinary incontinence in children and adults: A short version Cochrane systematic review and meta-analysis,” a paper with at least two independent review others carrying out trial assessment, selection, and data abstraction, “women undergoing urodynamics were more likely to have their management changed (17% vs. 3% with a risk ratio of 5.07 and a confidence interval of 1.87-13.74.” The paper did indeed conclude that there was no difference in incontinence between women undergoing urodynamic studies versus those that have not. This indicates that not only does a urodynamic study not directly treat incontinence, it does not cause it or make it worse.

In another paper published in Neurology and Urodynamics entitled, “Good Urodynamic Practices: Uroflowmetry, filling cystometry, and pressure-flow studies,” a report is given defining good practices, issues that arise while testing such as artifact correction, signal testing, plausibility controls, and pattern recognition. Urodynamics is shown to be a well-established study that influences clinical decisions and the urodynamic studies, themselves, help indicate the correct plan of action.Urodynamic

Bladder outlet obstruction is both common in men and women as a cause for lower urinary tract symptoms. According to a review published in Reviews of Urology entitled, “Pressure Flow Urodynamic Studies: The Gold Standard for Diagnosing Bladder Outlet Obstruction,” Bladder outlet obstruction is, by definition, determined through urodynamic testing. Urodynamic testing has been utilized for decades and since the 1960’s, work has been performed to standardize the studies. One important distinction the paper makes is that, “recent work suggest that although the definition of obstruction may differ between men and women, the concept of the pressure-flow relation to diagnose obstruction holds true for both genders.”

Independent Review Urodynamics

Are urodynamic tests useful in diagnosing every cause of incontinence? The short answer is “no,” the long answer, as always, is more complicated, but can be summarized by making note that a urodynamic study is performed to help diagnose cause of incontinence and also helping to rule out other causes. An urodynamic study, as with any tool at a physicians finger-tips, must be used correctly and it is up to the physician to utilize his/her training in order to determine the need for the test. This point is illustrated in the paper, “Does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta-analysis.” The conclusion is that “In women undergoing primary surgery for SUI (stress urinary incontinence) or stress-predominant MUI (mixed urinary incontinence) without voiding difficulties, urodynamics does not improve outcomes – as long as the women undergo careful office evaluation.” This does indeed indicate that there is a judgment call on when to use urodynamic tests to diagnose and treat incontinence but only for specific causes. It is up to the health care provider to determine whether or not a test is going to be medically necessary instead of indicating what is already suspected.

How is a patient’s outcome influenced by an urodynamic study? With specific exceptions, a urodynamics study is needed in order to help determine specific causes of incontinence. Once identified, treatment can begin and the pathology causing incontinence can be reversed.

Is incontinence improved directly or indirectly? Urodynamic studies are, as with most tests, utilized in order to help determine the cause and not actually treat the problem. Therefore, they help treat incontinence indirectly.

Does an urodynamic study actually influence clinical decision making? When used correctly, mainly in the absence of stress urinary incontinence and/or stress-predominant mixed urinary incontinence, an urodynamic study does influence clinical decision making and improves patient outcome.