AUA 2013 - Session Highlights: Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction - Annual Meeting at the AUA

SAN DIEGO, CA USA (UroToday.com) - The focus of the meeting was “Utility of Urodynamics (UDS) in Clinical Practice,” with 10 minute presentations on multiple topics related to UDS.

At the beginning of the program, several speakers outlined the current gaps in LUT measurement (Victor Nitti), UDS measurement of lower urinary tract physiology (Bill Steers), and how well current UDS testing measures lower urinary tract function (Gary Lemack). Dr Lemack noted that DO is a more common finding in men with OAB than in women with OAB. UDS is most helpful in voiding phase abnormalities. He provided the evidence of when UDS can be helpful in OAB, SUI, DO, and BOO. He acknowledged that an area where there is a need for further research is detrusor underactivity. Although the goal of UDS is to reproduce a patient’s symptoms, this is not always done.

Dr. Alan Wein moderated the session on UDS standardization. The importance of UDS standardization was emphasized by Dr. Werner Schaefer. Dr. Elizabeth Muller presented the results of urology residents' UDS experience during training that was obtained from a needs assessment survey. At least 94% of newly trained urologists performed UDS in their first year of practice. When looking at the UDS diagnostic codes, complex uroflow codes were predominant in men with BPH and UUI. Majority of voiding CMGs were performed on women with SUI. But less than 9% of these new-to-practice urologists ever performed a video UDS, and, if done, the tests where split between men and women, primarily with a neurogenic bladder diagnosis. In residency, only 77% get exposed to UDS, 84% get to interpret the tests, but only 32% had ever actually performed a UDS. SUFU has developed the Urodynamics Curriculum for Urology Residents, an eLearning program found at http://elearning.sufuorg.com/. To date, 608 have registered to take the curriculum, but this 4-module curriculum does not solve the need for residents to actually perform the study. Residents need to be in the room, doing the actual test, calibrating the catheters, operating the equipment, etc.

Dr. Steve Kraus reviewed the AUA Adult UDS guideline detailing the extensive search performed and the key guideline statements. He commented that UDS should be performed to assist the clinician in reproducing a patient’s symptoms to make a diagnosis, not for determining outcomes. In patients with neurologic disease, UDS can be most helpful in determining both storage and voiding problems. UDS should be tailored to the individual patient’s needs, and it is recognized that there should be more selective application of UDS tests. The meeting progressed with lectures on neurogenic bladder, a post-prostatectomy incontinence point/counterpoint that debated the need for UDS prior to sling surgery (Craig Comiter) and no need for UDS prior to treatment (Sender Herschorn). The use of UDS for patients with OAB and CPP was presented by Dr. Toby Chai. Identifying which female patient with SUI should undergo pre-operative UDS was a presentation by Dr. Chuck Nager. Final presentations included a point/counterpoint on male LUTS where Dr. Ajay Singla felt that the cause of symptoms in men with LUTS can be determined non-invasively, but Dr. Steve Kaplan made a strong argument for the use of pressure/flow studies to guide treatment.

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Urodynamics: The gap between what they measure and what we need them to measure
Moderator: Victor W. Nitti, MD

UDS measurement of lower urinary tract physiology
William D. Steers, MD

How well wo the current UDS define the underlying mechanisms responsible for lower urinary tract conditions?
Gary E. Lemack, MD

Urodynamics standardization
Moderator: Alan J. Wein, MD, FACS, PhD (Hon)

Why we need to follow the UDS practice guidelines
Werner Schaefer, MD

Urodynamic education
Elizabeth R. Mueller, MD

AUA clinical guidelines for adult urodynamics
Stephen R. Kraus, MD

UDS helps me decide who I’m going to sling
Craig V. Comiter, MD

No need for UDS prior to treatment
Sender Herschorn, MD

OAB and CPP: Can UDS help differentiate between the two?
Toby C. Chai, MD

SUI–Which patients should have pre-operative UDS
Charles Nager, MD

Non-invasive studies can answer most questions
Ajay K. Singla, MD

Pressure/flow studies help guide treatment
Steven A. Kaplan, MD

Presented at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Annual Meeting preceding the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

 

Reported for UroToday.com by Diane K. Newman, DNP, ANP-BC, FAAN

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