Introduction to Urodynamic Science

Module details

Title

Introduction to Urodynamic Science

Type

Rotation

Module code

SPS303

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with a generalised body of knowledge that will introduce and underpin the work based rotation in Urodynamic Science. This rotation will enable trainees to gain experience of the range of clinical diagnostic investigations undertaken within Urodynamic Science and the interaction with patients and patient-centred practice. Trainees will be expected to observe a range of routine urodynamic investigations, gain practical skills in setting up and maintaining the equipment used, produce technical reports, explain procedures to patients and gain consent, and develop and build their professional practice.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2,3	Competency Control infection risks in accordance with departmental protocols.	Action View
# 2	Learning outcome 2	Competency Carry out routine maintenance and calibration procedures on equipment used in: flowmetry residual urine assessment by ultrasound cystometry.	Action View
# 3	Learning outcome 1	Competency Select suitable technology for the investigation of common lower urinary tract (LUT) symptoms.	Action View
# 4	Learning outcome 1	Competency Set up equipment used for routine investigations in a flowmetry clinic and cystometry clinic.	Action View
# 5	Learning outcome 1,2	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 6	Learning outcome 2	Competency Ensure accurate completion of equipment  maintenance records.	Action View
# 7	Learning outcome 3	Competency Obtain a suitably completed request form, greet the patient and check patient identity.	Action View
# 8	Learning outcome 3	Competency Treat patients in a way that respects their dignity, rights, privacy and confidentiality.	Action View
# 9	Learning outcome 3	Competency Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.	Action View
# 10	Learning outcome 3	Competency Explain the procedure to the patient and address any questions they may have relating to the procedure.	Action View
# 11	Learning outcome 3	Competency Gain informed consent (under supervision).	Action View
# 12	Learning outcome 3	Competency Inform the patient of the procedure for notification of results.	Action View
# 13	Learning outcome 4	Competency Review the results from the test, taking into account artefacts, necessary adjustments of values and planned/unplanned events occurring during the test.	Action View
# 14	Learning outcome 4	Competency Compare the values/traces obtained with the normal range/values related to the procedure.	Action View
# 15	Learning outcome 4	Competency Produce a clear written technical report of the	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Set up equipment ready for use in a Flowmetry Clinic and Cystometry clinic.	DOPS
Carry out routine maintenance and calibration procedures on equipment used in Flowmetry, Residual Urine Assessment by Ultrasound and Cystometry.	DOPS
Gain patient consent	DOPS
An appropriate activity agreed with your Training Officer	OCE

Learning outcomes

1. Set up equipment ready for use in a flowmetry clinic and cystometry clinic.
2. Perform routine maintenance and calibration procedures on equipment used in flowmetry, residual urine assessment by ultrasound and cystometry.
3. Gain informed consent, under supervision, from a minimum of five male and five female patients for flowmetry, residual urine assessment by ultrasound, and filling and voiding cystometry.
4. Produce written technical reports from a range of routine urodynamic investigations, including flowmetry, residual urine assessment by ultrasound, and filling and voiding cystometry.

Learning outcomes

1. Recall the anatomy and physiology of the male and female urinary system and describe the parasympathetic and sympathetic and somatic nerve supply in relation to the lower urinary tract and pelvic floor muscles.
2. Describe the pathophysiology of lower urinary tract disorders and describe conditions including different types of storage and voiding dysfunctions.
3. Explain the clinical concepts of urethral catheterisation, including infection control and asepsis, and any complications and side effects associated with catheterisation.
4. Describe anorectal anatomy and pathophysiology.
5. Describe techniques used in the investigation of the lower urinary tract.
6. Discuss the types of catheter and the indication for use for urodynamic investigations.
7. Recognise the range of different types of Urodynamics and the role of each investigation.
8. Explain the principles of Quality of Life (QoL) evaluation and the use of Patient Reported Outcome Measures (PROMs).

Indicative content

Anatomy and physiology

• Structure and function of the urinary tract, including the upper and lower urinary tract
• Anatomy of the urinary bladder, the bladder neck and urethra
• Anatomy of the pelvic floor complex, including the pelvic floor muscles
• Anatomy of the anorectum, including the anal sphincters

Neurophysiology

• Somatic, parasympathetic and sympathetic nerves
• Concept of neurotransmitters in relation to the lower urinary tract

Pathophysiology

• Risk factors
• Pathophysiology of lower urinary tract symptoms, including:
  • types of incontinence
  • voiding problems and associated lower urinary tract symptoms (LUTS)

History taking

• Pathophysiology of the lower urinary tract and LUTS to be able to focus history taking on urodynamics
• Explain and interpret frequency/volume charts to relate these findings to the symptoms

Pharmacology

• The effect of:
  • antimuscarinics
  • alpha blocking agents
  • alpha 5 reductase inhibitors
  • other medication that acts on the lower urinary tract

Terminology

• Current International Continence Society terminology relating to lower urinary tract symptoms and urodynamic diagnoses

Device design and technology

• Types of urodynamic equipment available
• Safe storage and handling of catheters and transducers
• Electrical safety of equipment
• Different types of urodynamic investigations and the role for each

Catheterisation technique and complications

• Environmental requirements and considerations
• Equipment required
• Documentation required
• Cessation of medication
• Complications and their significance

Follow-up

• Data upload
• Equipment and personnel
• Clinic design
• Databases and patient records
• Patient support material
• Emergency equipment
• Troubleshooting
• Optimal monitoring procedures
• Principles of outcome measurement and QoL evaluation
• Role of PROMs

Associated regulations

• Conduct of clinical trials

Activities

• Observe a range of routine urodynamic investigations (flowmetry, urinalysis, residual urine assessment by ultrasound, filling cystometry, voiding cystometry), critically evaluate the investigations undertaken by a urodynamic science service and understand the importance of other clinical specialisms in the investigation of diseases of the urinary tract.
• Observe a range of routine urodynamic investigations (flowmetry, urinalysis, residual urine assessment by ultrasound, filling cystometry, voiding cystometry) and critically evaluate the role of the urodynamic diagnostic service in the management and treatment of patients with lower urinary tract (LUT) disorders.
• Observe history taking in patients with diseases of the urinary tract, develop and practise the skill of history taking, present your history findings for a range of patients and suggest appropriate investigations based on this information.
• Attend outpatient clinics and/or inpatient ward rounds and/or physiologist-led clinics and discuss with your supervisor the clinical specialisms linked to Urodynamic Science in the investigation of diseases of the urinary tract.
• Attend a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with disorders of the urinary tract.