Describe the experience of discomfort, anxiety, shame and overall performance of the urodynamic study in patients who were submitted to this procedure in order to evaluate lower urinary tract symptoms

Mixed study exploring the experiences of adults who required a urodynamic study as part of their lower urinary tract symptoms evaluation at a reference center was conducted. Data were collected through a structured survey in which two open questions were included. These questions were conducted by one of the researchers as a semi-structured interview.  Codification of the results was done by one researcher. Units of analysis were categorized to identify emotions and experiences. Data was synthesized into themes which were reviewed and discussed with co-authors.

Participants were mean 58,5 years old in a range between 42-85 years old, 8 were male and 7 females. Most of them had an undergraduate degree and lived with their families. Regarding discomfort, most patients qualified their experience according to a VAS as a moderately uncomfortable one (median 5, IQR 4.5-8).  Out of the patients who said they felt anxiety during the procedure, they stated that it was mainly because of fear of what was being done. Patients felt that the information given was clear and very similar to the actual exam. Those who thought that the procedure was going to be more uncomfortable or painful, felt that they were expecting a lot more discomfort than the one they experienced. Most participants acknowledged the medical and nurse staff´s work and how this made the exam more tolerable emphasizing on the importance of receiving guidance through the whole process.

Our data present experiences from 15 participants, an appropriate sample for qualitative study designs. Participants contrasted their perceptions before and after the exam which allows understanding if the information received before the exam is important for its development.  

Subjects mainly described the exam as a tolerable one.  However, the scores on the discomfort VAS are grouped above a score of 4.5 with a median score of 5, being a moderately uncomfortable exam discomfort was associated with position during the exam and requirement of catheter placement. In our group females stand both discomfort and shame more than males and are willing to undergo the exam a second time if necessary. Multiple factors can influence pain perception, including previous expectations, previous painful experiences, emotional state, cognitive, ratial and cultural factors. This is important in terms of evaluating and understanding the population treated in our center. 

There are few studies exploring qualitative perceptions of urodynamics in different populations. Our study group composed mainly by Latin/Hispanic patients showed better adaptability from females to experiences during the urodynamic study. Larger scale studies are needed to determine if this influences the results obtained during different phases of urodynamics and the follow up of patients with a variety of lower urinary tract conditions.  

The theme “information received” provided important information as it showed that the education given before the exam was a high quality one.  For subjects interviewed both the information given verbally before the exam and the fact that the examiner gave detailed instructions through the whole procedure and helped patients understand better what they were going through. 

We highlight patients' positive comments on the staff´s attitude and disposition. Although this center is a University Hospital, where trainees are medical students and residents, patients did not have any inconvenience with having them in the exam room.  Being part of a teaching hospital demands for practices to be updated according to international guidelines to assure good clinical practices and the delivery of a high-quality exam with objective results.

This study provides insight into the patient´s experience on the urodynamic study. Subjects evaluated were both male and female which allows a better understanding of different perceptions between sexes. Being able to understand these experiences allows a better communication of the procedure dynamics. It is important for a discussion with the patients regarding their perceptions and expectations on the study. It can also guide discussions around better clinical practices and standards of care in centers where these studies are conducted.