Urodynamic studies are on the rise

Key Points

St. Petersburg, FL-The number of urodynamic studies conducted by urologists applying for board certification or recertification more than doubled in less than a decade, with most of the procedures being performed in men with symptoms of urinary obstruction and in women with urinary incontinence, researchers from Loyola University, Chicago, report.

"We are designing a curriculum for all urology residents in the United States to ensure they understand the indications for urodynamics in addition to performing and interpreting studies," said Dr. Mueller, assistant professor of urology and OB/GYN at Loyola.

In the current study, Drs. Mueller and Kenton reviewed procedure logs from those applicants to compile urodynamics-related Current Procedural Terminology codes and the number of urologists performing the procedures. They reviewed logs from 2,650 different urologists, of whom about two-thirds were applying for recertification and one-third were first-time applicants.

High rate of uroflowmetry

Of the 634,000 total urodynamic studies reviewed, complex uroflowmetry was performed by 83% of the urologists and represented almost half (47%) of the total number of studies reported. Three-fourths of uroflowmetry studies were performed on men, with the most common ICD codes connected to urinary obstruction and frequency.

Among women, the ICD codes for urodynamic studies were most commonly for stress or unspecified urinary incontinence. More than 65% of filling and voiding cystometry was performed on female patients.

"We try and teach residents that not all urinary tract conditions require urodynamics," Dr. Mueller said. "In fact, many patients can be diagnosed and offered treatment options based on their symptoms.

"Urodynamics are indicated when they will benefit the patient or change your treatment plan."

She added that urodynamics can also aid in preoperative counseling, and that "because they are often used prior to a surgical procedure, it is sensible that most urodynamic studies would be performed in men with symptoms of obstruction and women with stress incontinence."

Interestingly, only 4% of studies reviewed were video-urodynamic studies. The majority of those (85%) were performed on women with an ICD code associated with unspecified or stress incontinence.

"I was surprised by that," said Dr. Mueller. "Based on my training in residency, I would have assumed that the majority of video-urodynamic studies were being performed for patients with spinal cord injury or anatomic abnormalities such as urethral stricture or vesicoureteral reflux."

Dr. Mueller went on to acknowledge that studies like this one "are limited in that we cannot capture every ICD-9 code, and it could be that the majority of these studies are being performed for unique indications that justify the use of video-urodynamics."

Dr. Mueller's previous paper was not able to offer any firm reasons why the incidence of urodynamic procedures would rise so quickly, though she says a possible explanation is that "urodynamics have increased with an increase in procedures being performed to treat stress incontinence and BPH over the last 5 years, though I'm not sure those procedures have doubled in the same time."