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AUA 2018

AUA 2018: The Utility of Urodynamic Evaluation in Clinical Practice

San Francisco, CA USA (UroToday.com) This moderated poster session included several studies regarding the quality of urodynamic studies (UDS) and whether they add to treatment planning in patient management. The publication of the VALUE trial in 2012 caused many clinicians to question the utility of urodynamics. However, many urologists have argued that the patient population in this trial was of minimal complexity and the results of this landmark trial do not apply to the general clinical population. Rena Malik, MD and colleagues sought to evaluate the value of urodynamic studies in their patient population, a tertiary referral center.

The authors prospectively evaluated patients who underwent urodynamic testing as part of their clinical evaluation by three physicians who specialize in female pelvic medicine and reconstructive surgery. The physicians were surveyed before and after the urodynamic study. The primary outcome evaluated was the impact of the UDS on the treatment plan (ie, whether the treatment plan was changed based on the study). They also assessed physician confidence (on a 5 point Likert scale) with the treatment plan, subjective helpfulness of the study, and the reproducibility of the symptoms during the study.

The results of the study showed that the treatment plan was changed based on the UDS 78% of the time, most commonly resulting in a change to conservative management. They was particularly true in patients presenting with MUI, who were significantly more likely to have a change in the treatment plan as compared to other diagnoses. The studies were subjectively helpful 94% of the time, most commonly because they answered the question that was asked (74%), and also because they provided information on voiding dysfunction (57%), bladder capacity (38%), detrusor function (55%), and the outlet (35%). Physician confidence increased from a mean of 2.9 to 4 after the study. 96% of studies were determined to be able to reproduce patient symptoms, at least partially.

This study demonstrates the significant impact that UDS can have on not only treatment planning, but also physician confidence with the treatment plan. In addition, the vast majority of studies were found to be helpful for various reasons and were able to reproduce patient symptoms. Because the studies were performed at a tertiary referral center they may not be applicable to the general urology clinical practice. Nonetheless, clinicians should strongly consider performing UDS in any situation where the diagnosis is unclear, especially when invasive treatment is considered.

Presented by: Rena Malik, MD; UT Southwestern Medical Center

Co-Authors: Juan Garisto, Jaya Chavali, Jihad Kaouk, Cleveland, OH

Written by: Dena Moskowitz, MD; Fellow, Female Pelvic Medicine and Reconstructive Surgery, Virginia Mason Medical Center, Twitter: @demoskowitz, at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

Reference:
Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before