Urodynamics tests: what do patients think?

01 March 2019, Tim Burton - 

There is a gap in our knowledge around urodynamic testing for lower urinary tract symptoms (LUTS): there’s little evidence available on how men feel about the test. Is urodynamics helpful for men when deciding which treatment to opt for, or is the procedure’s invasiveness too great to justify its use?

Dr Lucy Selman and colleagues at the University of Bristol have recently published a qualitative study that seeks to find answers.

The study

Lucy Selman2The team in Bristol recruited and interviewed a group of 41 men experiencing LUTS symptoms. Of this group, 25 had undergone urodynamics and 16 had not. The study focused particularly on men as although men have featured in studies looking at both genders, no previous research has focussed on understanding men’s experiences and views of urodynamics in an in-depth way.

The men interviewed were taking part in the Urodynamics for Prostate Surgery: Randomised Evaluation of Assessment Methods (UPSTREAM) randomised controlled trial, a 4-year study funded by the National Institute of Health Research. The trial randomised 820 men with LUTS from urology departments in 26 hospitals in England to either a care pathway consisting of non-invasive routine tests, or one of routine tests plus urodynamics. At 18-months after randomisation, UPSTREAM assessed the effect of urodynamics on symptoms and rates of surgery in men with bothersome LUTS seeking further treatment.

The qualitative research embedded in the trial aimed to assess how acceptable men found urodynamics. Did the risks and the discomfort of an invasive procedure outweigh the potential benefits of a urodynamics test?

The results

Of the 25 men who had experienced invasive urodynamics testing, all believed the procedure was acceptable. Of the 16 who did not undergo invasive urodynamics testing, 14 said they would undergo the test if it was necessary and two more requested more information. Of these 14 men, 4 remained apprehensive about the test. The headline is that urodynamics testing is well tolerated by the men who undergo it.

“I like answers… and we got the answers. So if I hadn't had the test done, then we're just left with a load of symptoms which could be caused by this or that. Erm, so I mean in terms of erm the invasion of the test, it's… not a problem… totally acceptable.” MrPT20, age 69

“I was glad that it was a clear result in itself… it was effective in actually showing, illustrating the problem and the extent of the problem…it was effective in actually getting something sorted.” MrPT22, age 64

Although the test was generally well tolerated, there were still concerns around discomfort and embarrassment.

“Having a tube stuck inside me and afterwards was 10 out of 10 pain… It was awful. But the people I dealt with were very good.” MrPT6, age 57

“It was all right. Embarrassing [laughs]! Stood there in front of all the people!… There were a couple of students! [Laughs] A couple of nurses! [Laughs]” MrPS11, age 59

“The final pee that I was having was with a catheter up my urethra. Now, how you're supposed to pee into a jug when you've got a catheter up you, I do not know. But it went all over the wall and the floor, er, which embarrassed me. If they'd said, ‘Look, this is what's going to happen, don't worry about it’… One of the nurses had to clean it all up when she came back in.” MrPT10, age 63

The recommendations

Based on these interviews, the team in Bristol have made four recommendations for clinicians who are handling urodynamic testing:

  1. Good communication: The men who underwent urodynamics testing felt more comfortable about the procedure when they were fully informed about what it entailed and what it would mean for them physically. Clinicians are encouraged to provide full information to patients so that they can be more prepared for the procedure.
  2. Prioritising patient privacy: The men who were interviewed felt more self-conscious and embarrassed if they underwent the procedure in a room full of people, in a large room, or in a room just off a busy corridor. The team recommend using smaller, more isolated rooms, and introducing any other people in the room at the time of the procedure.
  3. Discuss results promptly, but appropriately: The delivery of results varied between the men interviewed. Some received initial results while the test was still underway, whilst one man received his results while he was still getting dressed. Clinicians should ensure that patients receive their results promptly, but also when they are able to engage appropriately with what they’re being told.
  4. Training and guidance: A greater emphasis should be placed on training and providing appropriate guidance for clinicians who perform urodynamics testing. This will ensure that patients receive consistently high-quality care during the urodynamics procedure.

The conclusions

Urodynamics is not without its problems, most notably discomfort and embarrassment, but the men who were interviewed as a part of this study believed it was a worthwhile procedure which provided them with the clarity they needed to make decisions regarding their future treatment.

Provided the procedure is conducted correctly, the urodynamics test is likely to be well-tolerated by most male patients.

 

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Prostate

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