Minimum standards for urodynamic practice in the UK

Singh, Gurpreet; Lucas, Malcolm G; Dolan, Lucia; Knight, Stephanie; Ramage, Carmel; Hobson, Philip Toozs

doi:10.1002/nau.20883

Cited by 31 publications

(29 citation statements)

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“…The urodynamic state of the lower urinary tract was evaluated in accordance with the International Continence Society guidelines [26-28]. A UDS "Relief-01" (DALPRIBOR, Vladivostok, Russia) with double-catheter microtip (UROBAR, CH 9; Raumedic AG, Helmbrechts, Germany) was used for the standard urodynamic procedure.…”

Section: Methodsmentioning

confidence: 99%

Maintenance of the Therapeutic Effect of Two High-Dosage Antimuscarinics in the Management of Overactive Bladder in Elderly Women

et al. 2013

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PurposeTo improve the long-term efficiency of the pharmacologic management of overactive bladder (OAB) in elderly women.MethodsThe study comprised 229 women (mean age, 66.3 years; range, 65-77 years) with urodynamically and clinically confirmed OAB. All patients received the most effective treatment regimen based on the data obtained in the initial part of the study (trospium 60 mg/day + solifenacin 40 mg/day, for 6 weeks), and positive results similar to those in the first phase were obtained. They were then divided into four groups, based on the maintenance therapy: group A (59 women), trospium (60 mg/day) + solifenacin (40 mg/day) for 1 month; group B (51 women), electrical stimulation of the detrusor muscle for 1 month; group C (63 women), laser puncture for 1 month; group D (56 women), placebo. Maintenance therapy was administered 2.5 months after completion of primary treatment. The patients' condition was monitored through the OAB questionnaire for 1 year and by urodynamic examination at months 6 and 7 from the start of the study.ResultsIn group A, the clinical and urodynamic results achieved after the initial + main treatment phase (two high-dosage antimuscarinics of different generations, trospium and solifenacin, for a total of 2.5 months) were maintained for at least 7 months. Electrical stimulation of the urinary bladder as a method of maintenance therapy proved to be less effective. In groups C and D, deterioration in results was observed at 6-8 months, which led us to conclude that laser puncture was an inefficient method of maintenance therapy in elderly women with OAB.ConclusionsMaintenance treatment of OAB in elderly women with a combination of high-dosage antimuscarinics is an effective method for reducing the risk of recurrence of the disease.

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Section: Methodsmentioning

confidence: 99%

Maintenance of the Therapeutic Effect of Two High-Dosage Antimuscarinics in the Management of Overactive Bladder in Elderly Women

et al. 2013

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“…59,60 For this reason, we do not feel it appropriate to give a detailed description of the interventions in accordance with the TIDieR guidelines. 61 Readers wishing to understand more about the interventions might refer to standard texts, 62,63 or to standardisation documents.…”

Section: Interventionsmentioning

confidence: 99%

“…61 Readers wishing to understand more about the interventions might refer to standard texts, 62,63 or to standardisation documents. 59,60 Further investigation was undertaken, where appropriate, at the same visit or a later one, as per local custom, and the treatment plan formulated.…”

Section: Interventionsmentioning

confidence: 99%

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): a mixed-methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing prior to surgery for stress urinary incontinence in women

Hilton

Armstrong

Brennand

et al. 2015

Health Technology Assessment

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BackgroundThe position of invasive urodynamic testing in the diagnostic pathway for urinary incontinence (UI) is unclear. Systematic reviews have called for further trials evaluating clinical utility, although a preliminary feasibility study was considered appropriate.ObjectivesTo inform the decision whether or not to proceed to a definitive randomised trial of invasive urodynamic testing compared with clinical assessment with non-invasive tests, prior to surgery in women with stress UI (SUI) or stress predominant mixed UI (MUI).DesignA mixed-methods study comprising a pragmatic multicentre randomised pilot trial; economic evaluation; survey of clinicians’ views about invasive urodynamic testing; qualitative interviews with clinicians and trial participants.SettingUrogynaecology, female urology and general gynaecology units in Newcastle, Leicester, Swansea, Sheffield, Northumberland, Gateshead and South Tees.ParticipantsTrial recruits were women with SUI or stress predominant MUI who were considering surgery after unsuccessful conservative treatment. Relevant clinicians completed two online surveys. Subsets of survey respondents and trial participants took part in separate qualitative interview studies.InterventionsPilot trial participants were randomised to undergo clinical assessment with non-invasive tests (control arm); or assessment as controls, plus invasive urodynamic testing (intervention arm).Main outcome measuresConfirmation that units can identify and recruit eligible women; acceptability of investigation strategies and data collection tools; acquisition of outcome data to determine the sample size for a definitive trial. The proposed primary outcome for the definitive trial was International Consultation on Incontinence Modular Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) (total score) 6 months after surgery or the start of non-surgical treatment; secondary outcomes included: ICIQ-FLUTS (subscales); ICIQ Urinary Incontinence Short Form; ICIQ Lower Urinary Tract Symptoms Quality of Life; Urogenital Distress Inventory; EuroQol-5D; costs, quality-adjusted life-years (QALYs) and incremental cost per QALY, Short Form 12; 3-day bladder diary.ResultsOf 284 eligible women, 222 (78%) were recruited; 165/219 (75%) returned questionnaires at baseline and 125/200 (63%) who were sent questionnaires at follow-up. There were few missing data items in returned questionnaires, with individual outcome scales calculable for 81%–94%. Most women underwent surgery; management plans were changed in 19 (19%) participants following invasive urodynamic testing. Participant Costs Questionnaires were returned by 53% 6 months after treatment; complete data to undertake cost–utility analysis were available in 27% (intervention) and 47% (control). While insufficient to recommend changes in practice, the results suggest further research would be valuable. All clinicians responding to the survey had access to invasive urodynamic testing, and most saw it as essential prior to surgery in women with SUI with or without other symptoms; nevertheless, 70% considered the research question underlying INVESTIGATE important and most were willing to randomise patients in a definitive trial. Participants interviewed were positive about the trial and associated documentation; the desire of some women to avoid invasive urodynamic testing contrasted with opinions expressed by clinicians through both survey and interview responses.ConclusionsAll elements of a definitive trial and economic evaluation were rehearsed; several areas for protocol modification were identified. Such a trial would require to 400–900 participants, depending on the difference in primary outcome sought.Future workA definitive trial of invasive urodynamic testing versus clinical assessment prior to surgery for SUI or stress predominant MUI should be undertaken.Trial registrationCurrent Controlled Trials ISRCTN71327395.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…The study was carried out in accordance with the Declaration of Helsinki and international recommendations for urodynamic examinations (Gurpreet Singh et al, 2010;Schafer et al, 2002;Schroder et al, 2009). Patients over 65, who suffer from severe symptoms of overactive bladder (the frequency of episodes of incontinence (EI) !…”

Section: Methodsmentioning

confidence: 99%

A randomized, controlled trial of effectiveness and safety of management of OAB symptoms in elderly men and women with standard-dosed combination of solifenacin and mirabegron

Kosilov

Loparev

Ivanovskaya

et al. 2015

Archives of Gerontology and Geriatrics

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Minimum standards for urodynamic practice in the UK

Abstract: This is the first attempt to standardise urodynamics practice nationally. The document is available on the United Kingdom Continence Society websitewww.ukcs.uk.net.

Cited by 31 publications

References 3 publications

Maintenance of the Therapeutic Effect of Two High-Dosage Antimuscarinics in the Management of Overactive Bladder in Elderly Women

Maintenance of the Therapeutic Effect of Two High-Dosage Antimuscarinics in the Management of Overactive Bladder in Elderly Women

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): a mixed-methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing prior to surgery for stress urinary incontinence in women

A randomized, controlled trial of effectiveness and safety of management of OAB symptoms in elderly men and women with standard-dosed combination of solifenacin and mirabegron

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