An audit of urodynamic standardization in the West Midlands, UK

To report a follow-up postal survey to one conducted in 1998 assessing the feasibility of standardizing urodynamic practice in the West Midlands region.

From the initial survey there was interest in standardizing the practice of urodynamics and a few simple guidelines were proposed. The postal survey was repeated to identify any changes. The guidelines included zeroing the transducer to atmospheric pressure, a filling rate of 50 mL/min and using the International Continence Society (ICS) definition of detrusor instability, including numerical values and recording any contraction in the presence of urgency. A questionnaire, similar to the initial one, was circulated to all the clinicians who had participated in the initial study, distributed approximately 8 months after agreed guidelines were issued. Specific questions included details of the filling and voiding cystometrogram, and the basis of diagnosing detrusor instability. They were also asked to comment on whether they would still like the practice to be standardized.

Only 17 of the 23 clinicians who participated in the initial study responded. For zeroing the transducer to atmospheric pressure, eight still zeroed to the patient. Only one unit had changed its practice by zeroing to atmospheric pressure. Varied rates of filling were still used and only eight participants used the ICS criteria to diagnose detrusor instability. Three of the 17 participants did not feel that standardization was achievable.

Obviously there is some apathy amongst clinicians to move towards standardization. No significant changes had been made since standardization guidelines were issued. Although most preferred initially to standardize urodynamic practice, individuals do not seem to have been convinced that they need to change their method to achieve uniformity.