Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations

Abstract

Aims To review the recommendations on basic urodynamic testing in the International Continence Society (ICS) standardization documents, specifying key recommendations for delivery and interpretation in clinical practice. Methods Fundamental expectations described in the ICS standards on good urodynamic practices, urodynamic equipment, and terminology for lower urinary tract (LUT) function were identified and summarized. Results The ICS standard urodynamic protocol includes clinical history, including symptom and bother score(s), examination, 3‐day voiding chart/diary, representative uroflowmetry with post‐void residual, and cystometry with pressure‐flow study (PFS). Liquid filled catheters are connected to pressure transducers at the same vertical pressure as the patient's pubic symphysis, taking atmospheric pressure as the zero value. Urodynamic testing is done to answer specific therapy‐driven questions for treatment selection; provocations are applied to give the best chance of reproducing the problem during the test. Quality of recording is monitored throughout, and remedial steps taken for any technical issues occurring during testing. Labels are applied during the test to document events, such as patient‐reported sensation, provocation tests, and permission to void. After the test, the pressure and flow traces are scrutinized to ensure artefacts do not confound the findings. An ICS standard urodynamic report details the key aspects, reporting clinical observations, technical, and quality issues. Urodynamic services must maintain and calibrate equipment according to manufacturer stipulations. Conclusions The review provides a succinct summary of practice expectations for a urodynamic unit offering cystometry and pressure flow studies (PFS) to an appropriate standard.

Quality control of uroflowmetry and urodynamic data from two large multicenter studies of male lower urinary tract symptoms

“…Only one trace did not appear to have a “live” signal. Failure to interrupt filling in the event of urgency, DO or reduced compliance as per ICS recommendations 7 . Due to limited annotation or lack of filling rate information, this feature could not be evaluated in 75 out of 110 (68.1%).…”

“…The strengths of the current study were the use of quality control protocols derived from the ICS Fundamentals of Urodynamic Practice document, 7 random trace‐selection, and using specifically trained central readers blinded to the sites under review with expert adjudication for resolution of discrepancy. The main limitation was the necessity to sample 10% of traces, as this may give an unrepresentative picture of individual site performance, though this does not affect the overall evaluation.…”

“…Ten percent of uroflowmetry (30 sites) and urodynamics traces (26 sites) were selected at random from sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist 7 to examine parameters that could be identified from source traces and data (Table 1). Two pretrained blinded assessors (MA, JJ) independently extracted the data for each trace.…”

Urinary Symptoms and Bladder Dysfunction in Patients with Neuromyelitis Optica Spectrum Disorders: Evaluation with Urodynamics and Management

“…All definitions used were in accordance with the International Continence Society Report. 16,17 Filling cystometry was performed with patients in the supine position on the urodynamic table. Bladder filling performed with normal saline at medium fill rate (10-50 mL/minute).…”

Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer

“…Low bladder compliance (LBC) was defined as bladder capacity of less than 20 mL/cm H 2 O according to the International Continence Society standard. [ 12 ] Detrusor overactivity (DO) was characterized by involuntary detrusor contraction >5 cm H 2 O during the filling phase, which may be spontaneous or provoked. The UDS was terminated if patient reported a severe need to urinate, in case of significant leakage development, and the bladder capacity at that time was recorded as MCC.…”