The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms

Abstract

Background and Objectives: Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. Materials and Methods: This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. Results: In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6–10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16–20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. Conclusion: We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.

Learning Curve of a Low-Volume Veterinary Surgeon for Laparoscopic Salpingectomy in Asiatic Black Bear (Ursus thibetanus)

“…Although the ventral midline approach is preferable to the lateral flank approach in ovariohysterectomy, each method has its advantages and disadvantages (22,28,35,43). In large wild animals, the ventral midline approach may result in delayed wound healing at the surgical site and increased risk of potential rupture (9,27,31,34). Bears are wild animals that are dangerous and difficult to manage.…”

Flat Magnetic Stimulation for Stress Urinary Incontinence: A Prospective Comparison Study

“…Diagnostic confirmation may involve urodynamic evaluation due to the well-established poor correlation between clinics and instrumental findings in bladder dysfunctions [ 15 , 16 ]. However, the role of urodynamics is currently under debate due to different definitions and inconstant performance [ 17 , 18 ]. Management can vary from conservative to surgical treatment according to the severity of symptoms, their impact on quality of life, and the patient’s medical history and comorbidities.…”

Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study

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