Aims of study:
To determine the urodynamic facilities available, and urodynamic
test procedures in urogynaecology units in England and Wales. The last
survey of urodynamic equipments used in the UK was by Lewis et al in 19881.
More recently Hosker et al2 conducted a study to determine
the current practice of urodynamics in the UK but not the availability
of test equipment.
Methods:
A questionnaire was sent to one hundred urogynaecological units
in England and Wales in May / June 1999. Recipients were asked to complete
the forms or forward them to the most appropriate person in the department
if they were not currently involved in urodynamic testing of female patients.
Results:
We received
61 replies (61% Response rate) but one was excluded from analysis because
it was inadequately completed. Missing answers were also excluded from
analysis of individual questions.
Availability
of equipment (Response = 50)
|
Pad test
Free flowmetry
Urethral pressure profilometry
Bladder neck electrical conductance
Distal urethral electrical conductance test
Ultrasound scan
Static cystometry
Ambulatory cystometry
Video cystourethrography
Electromyography
|
30 (60%)
48 (96%)
28 (56%)
6 (12%)
5 (10%)
41 (82%)
50 (100%)
25 (50%)
24 (48%)
5 (10%)
|
Static cystometry
equipment manufacturer (Response
= 50)
|
Dantec
Lectromed
Albyn
Mms
Laborie
Micromedics
System 7
Dik
Mentor
“In house”
Combination
Not stated
|
19 (38%)
7 (14%)
4 (8%)
4 (8%)
1 (2%)
1 (2%)
1 (2%)
1 (2%)
1 (2%)
1 (2%)
2 (4%)
8 (16%)
|
Test methods
Only 51% of the units have a referral protocol for urodynamic
testing, and 84% would perform urodynamic testing on all patients with
urinary incontinence, whilst 5% would test only after failed surgery.
89% perform a urinalysis before testing, and 15% use prophylactic antibiotics.
92% complete a frequency volume chart before testing. 47% estimate
the residual urine with a combination of urethral catheterization and
Ultrasound scan, whilst 16% use a urethral catheter only. 10% have facilities
for DUEC testing, but only 1 (2%) use this routinely.
98% would perform both a filling and voiding cystometry, 2%
perform a filling cystometry only. 61% use normal saline for cystometry,
18% use sterile water, 10% use contrast, 8 % use both saline and contrast,
and 2% use “natural filling”. 88% fill the bladder with fluids at room
temperature, and 94% fill at a rate of between 10 – 100 ml/min. There
is a wide variation in filling catheter size, 23% use a 10fr catheter,
4% use a 4fr catheter. 63% use water filled pressure transducer, and 19%
use a micro-transducer.
67% remove the filling catheter prior to a voiding cystometry,
with 77% of the patients sitting for the voiding cystometry, and 17% using
a combination of sitting and standing positions for this test.
Conclusion:
This study shows the current state of urodynamics test equipment
availability and utilization in England and Wales. There appears to be
a wide variation in test facilities and procedures in urogynaecological
units. This therefore brings into question the reproducibility and comparability
of the test results produced from different units. There appears to be
a need for review of urogynaecological units in England and Wales, and
the development of guidelines on the minimum equipment standards, test
procedures and techniques for urogynaecological units.
References:
1. LewisP, Shepherd AM, Abrams PH. Urodynamics: which tests
and equipment are used? Neurourol Urodyn 1988; 7: 182 – 183.
2. Hosker Gl, Kilcoyne PM, Smith ARB. Urodynamic practice in
the UK. 28th Annual Meeting ICS, Jerusalem, Israel, 1998; pp 66 – 67 (Abstract)
