Opportunity for ICS Urodynamic Standardization: A Survey of ICS Members

Objectives: The ICS has published essential documents standardizing urodynamic technique and reporting. Currently, no consensus exists regarding patient prompts for bladder sensation, particularly in the setting of impaired bladder sensation (eg SCI). One ICS document recommends that three sensation parameters be recorded during cystometry: first sensation of filling (FSF), first desire to void (FDV) and strong desire to void (SDV). Another defines first sensation, first desire, normal desire, and urgency. The ICS 2019 terminology report on bladder sensation, cystometric capacity, first sensation, and maximum cystometric capacity. No published standardization exists for the reporting of rectal contractions or duration and amplitude of uninhibited contractions. The aim of our study is to evaluate current practice patterns among ICS urodynamicists regarding sensation prompts, mention of rectal contractions, and the extent to which uninhibited contractions are described. We hypothesize that wide variation in practice exists, identifying gaps in urodynamics standardization.

Methods: We conducted this mixed-methods investigation over 2 weeks via an emailed Qualtrics urodynamic testing survey distributed to all ICS members. The survey included 18 questions regarding provider and practice characteristics, urodynamic practice patterns, qualitative evaluation of coaching prompts given to patients regarding sensation during urodynamic testing, and rectal and uninhibited contractions. Data were analyzed using descriptive statistics.

Results: Of 2859 ICS members, 614 (21%) returned surveys. Of these, 35 did not perform urodynamic testing and 154 surveys were not completed. Thus, 425/614 (69%) surveys were included in our analysis. Participants were most commonly fellowship-trained female functional urologists (40%) and practiced in a government service hospital (46%). Half of the providers (55%) are present for the study 100% of the time. Most participants instructed patients on how to report sensation during UDS (59%). The sensation parameters most commonly utilized included First Sensation (86%), Urgency (86%), First Desire (85%), and Strong Desire (93%). Capacity was the least commonly used as a sensation parameter (54%). Various prompts for each of the UDS sensation parameters were reported including: repeating the ICS definition, real-life analogies, and a wide variety of other prompts. 45% of respondents altered instructions for patients with impaired sensation (e.g. SCI), 59% commented on the presence or absence of rectal contraction, and 70.4% characterized the amplitude and duration of UICs in their reports.

Conclusions: Although most survey participants report they standardize urodynamic instructions (74%), there is no consensus for sensation prompts within ICS urodynamic practice publications. We observed wide practice variation amongst providers including which parameters are utilized in testing as well as variation in coaching prompts. Other UDS parameters (whether to alter instructions in patients with impaired sensation, reporting of rectal contractions, and characterization of UICs) also lack standardization.