Urodynamic testing (by physiological measurements and or by relevant imaging or any other means of objective measurement) encompasses theoretically and technically well –developed, and thoroughly validated methods in clinical diagnosis, however the testing does not have a defined and official owner. Many feel responsible on personal grounds but the clinical practice of testing on the one hand and the evaluation and reporting of the tests on the other hand are usually separated, with regard to the individual being responsible. Scientific progress and development is furthermore not always integrated with hands on clinical practice and or with the practice of evaluation and reporting. The fact that objective testing of dysfunction of the lower urinary tract lacks an advocate makes it vulnerable to nihilism regarding its clinical value. This is in sharp contrast with, for instance the work of e.g. radiologists; clinical pathologists; neuro –physiologists; clinical -audiologists and or cardio -physiologists. Their tests and methods are not more validated than urodynamics but their advocacy is much stronger, resulting in better acknowledgement of the tests that they perform, the techniques that they use and the diagnoses that they produce.

I consider better awareness of the position of urodynamic testing in good clinical healthcare practice relevant. I consider improved privileging and credentialing of individuals performing urodynamics necessary and also this, especially for individuals evaluating and reporting the results of the tests. I am convinced that urodynamic diagnosis is indispensable (and comparable to radiology, pathology, cardio(vascular)-physiology etc.) in modern clinical referral practice.

You are wholeheartedly invited to this open forum-think tank discussion about this topic.

Peter F. W. M. Rosier. MD PhD,
Senior Lecturer Functional Urology and Neurourology,
Department of Urology, University Medical Center Utrecht,
The Netherlands