Amerikan Üroloji Derneği (AUA), kanıta dayalı ilk ürodinamik testi klinik rehberini yayımladı (İng)



AUA Releases First Guidelines for Urodynamic Testing

Yael Waknine – Nov 02, 2012Authors & Disclosures


The American Urological Association (AUA) has issued its first-ever set of evidence-based clinical guidelines for urodynamic testing. The guidelines are designed to help clinicians integrate urodynamics when treating patients with lower urinary tract symptoms.

“Urodynamics provide a wonderful tool to be utilized by a urologist. Unfortunately, we lack set algorithms to help guide patient selection for what many consider to be an uncomfortable, awkward, and invasive procedure for a patient. The new AUA/[Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction] guidelines for urodynamic studies eloquently guide urologists in patient selection for performing such testing,” David Josephson, MD, from Tower Urology at Cedars-Sinai Medical Center in Los Angeles, California, told Medscape Medical News.

The guidelines, published online October 23 in the Journal of Urology, are based on a literature review by an 11-member multidisciplinary panel convened by the AUA and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The panel reviewed 393 studies, ensuring that the guidelines reflect current clinical cases and conditions that urologists handle on a daily basis.

“Standardization with these recommendations will improve patient care and help clinicians practice both effectively and efficiently,” said Alexandra Rogers, MD, from Tower Urology, in an interview with Medscape Medical News.

Consider the Context

In contrast with “yes or no” algorithms that lead to blanket recommendations, the urodynamics guidelines are intended as a resource to help clinicians consider when and how urodynamic assessment may be helpful within certain clinical contexts.

For example, although urodynamic studies are considered optional in uncomplicated patients with stress incontinence, a pressure-flow urodynamic study may be warranted in women suspected of having other problems with bladder emptying or mixed symptomology, particularly if surgery is planned.

“The authors clearly justify the use of multichannel urodynamics prior to any invasive, potentially morbid, or irreversible procedures for stress urinary incontinence, pelvic organ prolapse, or lower urinary tract symptoms with detrusor overactivity. Preoperative studies can help counsel patients and set realistic expectations prior to surgery,” Dr. Josephson said. He noted that postoperative urodynamic studies can provide an extremely useful basis for comparison in the event of a less-than-ideal surgical outcome.

The guidelines also address the treatment of patients with neurogenic bladder, which can progress to renal damage and failure in patients with certain conditions such as spinal cord damage or myelomeningocele.

“The authors [emphasize] establishing a baseline urodynamic study for patients with neurogenic bladder dysfunction who will often require long-term urologic management. Such information proves useful, as voiding symptoms can change over time and urodynamics provide a quick, safe assessment of objective numbers to direct therapy and prevent damage to the upper tracts,” Dr. Rogers noted.

The commentators have disclosed no relevant financial relationships.

J Urol. Published online October 23, 2012. Abstract