ICS are pleased to confirm the official endorsement of the United Kingdom Continence Society (UKCS) document: "Minimum standards for urodynamic studies, 2018". To download a copy of this document please click on the below links.
Lower urinary tract dysfunction (LUTD) is prevalent worldwide and causes a major impact on quality of life. It is also a considerable burden, not only on those with conditions such as incontinence and voiding dysfunction, but also due the costs it incurs to the sufferers and society. This burden is increasing, as all populations are ageing. Unfortunately, lower urinary tract symptoms lack diagnostic specificity for the common conditions caused by detrusor overactivity (DO), stress urinary incontinence (SUI), bladder outlet obstruction (BOO) and detrusor underactivity (DU). Whereas it is acceptable to treat these conditions without a definite diagnosis by lifestyle interventions and behavioural therapy, with or without drugs, a significant number of patients are unimproved and request surgical solutions. As the bladder and urethra obey the laws of hydrodynamics, the only way to investigate their functional behaviour is by measuring pressure and flow: urodynamics (UDS). However, the published literature does not always support the use of UDS and the questions as to why this is require some thought. Urodynamics is carried out in one of eight physiological measurement units (PMUs) found in big hospitals: the others include respiratory function studies, neurophysiological studies and cardiac studies. In the UK, PMUs are staffed by clinical scientists who all have a Masterof Science degree. However, in this respect, UDS is different and is staffed by a variety of individuals, nurses, technicians, doctors, but few clinical scientists. There is little formal training for UDS staff, and no accreditation recognising their competence. This seems to be the case worldwide. Other PMUs have a designated clinician who specialise in the subject area, and provides leadership that ensures ongoing training, and regular auditing of quality. However this is not always the case in UDS. Hence UDS can be described as an outlier, that is different from the norm in other PMUs. In addition, ICS members will be aware that there have been a number of papers, and presentations at ICS, drawing attention to significant quality issues when UD traces are properly assessed for quality. These issues led the UKCS to produce its 2018 report on Minimum Standards for Urodynamics.
The UKCS working group included clinical engineer/scientists, nurses, gynaecologists and adult and paediatric urologists, and its report has been endorsed by the ICS and all the relevant professional bodies in the UK. It was published in Neurourology and Urodynamics in 2019. The report, for the first time, describes in detail the organisation of UD Units (UDU) and the technical and clinical skill sets required to carry out high quality UDS. These skill sets must be possessed by those that deliver the service to patients, and may be possessed by any of the groups of health care professionals involved. The report outlines the training methods that are needed to acquire the necessary skills. These methods include documented competence assessment through observation, and supervised practice of each aspect of UDS until the person’s competence allows independent practice. As UDS requires continuous dialogue with the patient during the test, it is essential that the UD team is integrated into the clinical department and that results are discussed through a multidisciplinary team (MDT), where audit for quality is a constant theme. This system ensures that the patient receives a safe and reliable test. The technical skill set means that the test will be of high technical quality using a properly maintained and regularly calibrated UD machine. The clinical skill set ensures that the patient is appropriate for UDS, that the appropriate tests are used, and that the patients symptoms are documented and reproduced during the test. If the symptoms are not reproduced then this means that the UDS have not fulfilled their essential aim, and the way forward needs to be considered by the MDT. The report covers the indications for, and the technical and clinical skills needed for the standard UD tests (uroflowmetry and filling and voiding cystometry), and advanced UDS (urethral function studies, and video and ambulatory UDS). The role of leadership for the UDU is vital and is responsible for all aspects of quality. The requirements described in the report make it clear that a formal accreditation of all individuals delivering the UD service must be mandated. In addition, reaccreditation is also needed at intervals of four or five years, and these topics are currently being developed by UKCS.
The UKCS report is available to ICS members on the Neurourology & Urodynamics website:
Enrico Finazzi Agro and Salvador Arlandis on behalf of ICS, and Paul Abrams on behalf of UKCS.
United Kingdom Continence Society: Minimum standards for urodynamic studies, 2018, PDF
United Kingdom Continence Society: Minimum standards for urodynamic studies, 2018. DOI 10.1002/nau.23909