The ICS Urodynamics Committee has continued to develop its Urodynamics teaching modules and the list of published modules continues to grow. The committee started these modules with the primary aim to ´teach the teacher´ which is a key strategic aim of ICS. The need for better education within the field of urodynamics is evident worldwide, especially the need for better education regarding the most predominant, valid and valuable diagnostical activity in lower urinary tract and pelvic muscle dysfunction, urodynamic testing. The committee felt this area required the most urgent attention and have therefore focused on these topics first.
Urodynamic testing education is available internationally but it is not taught in a standard format and with little in the way of scientific evidence. Also much of the education with regard to lower urinary tract dysfunction concentrated on symptoms and surgery and very little on the diagnostics and dianostical techniques itself.
Urodynamic testing is technically challenging and requires specific skills in cooperating with the patient as well as with the equipment. Moreover performing urodynamics requires the understanding of physiology and pathophysiology of the lower urinary tract. However, of utmost importance is the eventual evaluation: Urodynamics is as reliable as the person that evaluates it. Sadly enough there exist numerous examples of misinterpretations of urodynamic tests and (mis)interpretations of technically insufficient or inadequate tests in the scientific literature as well as in teaching books or on the internet.
The urodynamics committee started to develop teaching to improve the performing as well as the evaluation of urodynamic tests with the 3-part modules. The teaching modules, as outlined here above, designed to help others to provide better education by showing an example presentation together with a standard slides set -made available for anyone to view- and accompanied with a published background document with the evidence base for the performing and evaluation of elements of all testing. The 3-part model of the urodynamic committee’s teaching modules is currently adopted by the ICS as a whole and will be used by the new ICS institutes as the highest – scientific reliability- level of ICS teaching activity.
In Florence the Urodynamics Committee discussed its further strategy and apart from the continuation of the module’s content development the committee discussed 3 predominant challenges regarding urodynamics in the near future.
The first and predominant challenge concerns the perception of urodynamics. The committee agreed that currently ‘urodynamics does not look good’. This is reflected in view available in scientific literature, and on the internet.
Urodynamics could easily be as acceptable as radiology, being an equally technically challenging test, with costs and risks involved that requires similar type of expertise to uncover artefacts and establish a diagnosis independent of the signs and symptoms that the patient expresses. The evidence base for radiological investigation is usually also its face-validity in series of patients.
In scientific literature, the reporting of urodynamics is not standardised and both in clinically as in scientific reports incomplete and or ambiguous.
The second challenge concerns diagnostical power. Currently there is minimal evidence for the diagnostical power of many relevant elements of urodynamic tests. A few examples are: How irregular is a flowmetry? Is there really no good objective and quantifying parameter for detrusor overactivity load? How can female voiding detrusor contraction be quantified in the most reliable manner?
The final challenge concerns urodynamic equipment. The current equipment used to measure urodynamics is evolving but it also needs to further develop. User support systems, but also more reliable and or better reproducible measuring techniques for all parameters, with if possible, lesser dependence on operator handling, need to be developed.
The committee will therefore be working on addressing the above 3 concerns with the newly established ICS Urodynamics Institute, where we plan to continue delivering high quality education. The urodynamics committee will aim to make urodynamics look good again, will help to develop further testing and will strive to better application of existing and new scientific results. The Urodynamics Committee will continue this work under the guidance of Prof. Enrico Finazzi Agro, the new committee Chair.