Guideline linked to reduction in urodynamics testing

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Researchers have reported an association with the release of the AUA/SUFU Adult Urodynamics Guideline and reduction of urodynamics performed for diagnosis of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.

Researchers studying the impact of the 2012 release of the AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Adult Urodynamics Guideline have found an association between the guideline’s release and whether or not urologists use urodynamics testing.

Overall, there was an association with the release of the guideline and reduction of urodynamics performed for diagnosis of overactive bladder, stress urinary incontinence, and mixed urinary incontinence, according to the study’s first author Elizabeth Rourke, DO, MPH, who presented the findings at the SUFU winter meeting in Austin, TX.

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“These findings suggest that AUA guidelines, specifically the [Adult] Urodynamics Guideline, were associated with a change in clinical practice in that urologists were less likely to perform unnecessary urodynamics based on the recommendations of the guidelines,” said Dr. Rourke, of the University of Texas Health Science Center at San Antonio, who worked on the study with Stephen Kraus, MD, and colleagues.

The study did not find significant differences since the guideline release and use of urodynamics for women undergoing surgery for stress urinary incontinence or mixed urinary incontinence.

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Using a 5% sampling of Centers for Medicare & Medicaid Services (CMS) data from 2010 to 2014, Dr. Rourke and colleagues compared use of urodynamics before and after the guideline’s release in females diagnosed with overactive bladder, stress urinary incontinence, mixed urinary incontinence, and those undergoing surgery for stress urinary or mixed urinary incontinence. The CPT codes they used to define urodynamics were 51741 (complex uroflowmetry), 51726 (complex cystometrogram), 51727 (complex cystometrogram with urethral pressure profile studies), 51728 (complex cystometrogram with voiding pressure studies), and 51729 (complex cystometrogram with voiding and urethral pressure studies), according to the abstract.

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According to Dr. Rourke, key components of the Adult Urodynamics Guideline are recommendations for when use of urodynamics are appropriate in regards to diagnoses for overactive bladder, urinary urge incontinence, mixed incontinence, stress incontinence, neurogenic bladder, and lower urinary tract symptoms.

She said highlights of the Adult Urodynamics Guideline, in which the authors reviewed an evidence base of 393 studies, include:

Urodynamics may be performed in patients with stress urinary incontinence considering invasive procedures.
Urodynamics may be performed in patients with overactive bladder/urge urinary incontinence, where there is concern for altered compliance or detrusor overactivity and invasive procedures are being considered.
Urodynamics may be performed in relevant neurologic conditions in the initial evaluation of the patient to include complex cystometrogram, electromyography, and pressure flow analysis.

While the findings are positive, it’s imperative to remain abreast of the newest clinical information and recommendations by the AUA, in order to ensure that best practices are being adopted and unnecessary testing is not performed, according to Dr. Rourke.