Urodynamic Science 1

Module details

Title

Urodynamic Science 1

Type

Specialist

Module code

SPS321

Credits

10

Requirement

Compulsory

Aim of this module

This module provides trainees with the knowledge that underpins the specialist module in Urodynamic Science and gives these trainees the tools to undertake project based learning in the workplace. This rotation will enable trainees to perform a range of clinical diagnostic investigations undertaken within Urodynamic Science, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to undertake a range of routine urodynamic investigations, and build practical skills in setting up and carrying out first-line maintenance of the equipment used. They will be able to produce reports, interpret results and explain procedures to patients, 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 1,2,3	Competency Minimise risks and hazards in compliance with health and safety policies.	Action View
# 3	Learning outcome 1,2,3	Competency Select suitable technology for each type of investigation, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.	Action View
# 4	Learning outcome 1,2,3	Competency Set up equipment ready for use for each type of investigation.	Action View
# 5	Learning outcome 1,2,3	Competency Obtain a suitably completed request form, greet the patient, check patient identity and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system.	Action View
# 6	Learning outcome 1,2,3	Competency Explain each type of procedure to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results.	Action View
# 7	Learning outcome 1,2,3	Competency Gain informed consent for each type of investigation.	Action View
# 8	Learning outcome 1,2,3	Competency Obtain a clinical history as appropriate for each type of investigation.	Action View
# 9	Learning outcome 1,2,3	Competency Treat patients in a way that respects their dignity, rights, privacy and confidentiality.	Action View
# 10	Learning outcome 1,2,3	Competency Take appropriate action to respond to the specific needs of the patient, as defined by department protocol for each type of investigation.	Action View
# 11	Learning outcome 1,2,3	Competency Carry out each type of investigation.	Action View
# 12	Learning outcome 1,2,3	Competency Safely remove the catheters.	Action View
# 13	Learning outcome 3	Competency Review the results from each type of investigation, 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 each procedure.	Action View
# 15	Learning outcome 4	Competency Produce a clear written report of each type of investigation.	Action View

Assessments

You must complete:

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

Perform safe urethral catheterisation	DOPS
Perform safe insertion of rectal catheters	DOPS
Set up flowmetry equipment, give patient instruction and record results	DOPS
Set up cystometry equipment	DOPS
Measure volume of residual urine using ultrasound	DOPS
Carry out filling cystometry to national standards, choosing settings appropriate for patient	DOPS
Carry out voiding cystometry to national standards at appropriate point	DOPS
Recognise and take account of any artefacts present in measurements	DOPS
Interpret and report on flowmetry and residual volume data with respect to reported symptoms	DOPS
Interpret and report on filling and voiding data with respect to reported symptoms	DOPS
Conduct an infection control assessment appropriate to a piece of equipment	DOPS
Explain function of measurement catheters and insertion process	OCE
Check patient ID and obtain verbal informed consent for catheterisation	OCE
Take accurate and appropriate clinical history	OCE
Provide reassurance and maintain awareness of patients experience	OCE
Give clear patient instruction for flowmetry test	OCE
Give clear patient instruction for residual urine measurement	OCE
Take accurate and appropriate clinical history and take informed consent for a procedure	OCE
Communicate effectively with patient for understanding and repetition of symptoms during urodynamics	OCE
Clearly communicate post test instructions for the patient	OCE
Explain procedure and the risks and benefits with respect to the patients comorbidities and medication to the investigation to obtain written and informed consent.	OCE

Learning outcomes

1. Perform safe urethral catheterisation.
2. Perform safe insertion of rectal catheters.
3. Perform flowmetry, residual urine assessment by ultrasound, and filling and voiding cystometry in patients presenting with a range of conditions, for example urinary retention, urgency and stress incontinence.
4. Interpret the data and produce high-quality reports with respect to flowmetry, residual urine assessment by ultrasound, and filling and voiding cystometry.

Learning outcomes

1. Describe the anatomy and physiology of the lower urinary tract system, including bladder neck anatomy, function and descent, and apply knowledge to the pathophysiology, investigation and treatment of patients referred to a Urodynamic Science service.
2. Describe the autonomic nervous system, concepts of neuromodulation, and neurotransmitters in relation to the lower urinary tract.
3. Describe the pathophysiology and effect of pelvic organ prolapse and urological disorders and the appropriate choice of investigation, considering the findings from the history and clinical examination.
4. Explain the indications, contraindications, side effects and mode of action of medications potentially affecting the bladder.
5. Explain and justify the principles of safe working practice, infection control and allergies.
6. Describe and critically assess a range of techniques and instrumentation used in the investigation of the lower urinary tract, including flowmeters and cystometry.
7. Explain and justify the rationale and procedures for the investigation of lower urinary tract symptoms in a broad patient range, e.g. paediatric, adult, elderly, spinal injury and other neurological conditions.
8. Discuss and critically evaluate a range of different tests and equipment technology and design.

Indicative content

Anatomy and physiology

• Structure and function of the bladder neck
• Sphincter mechanism
• Bladder contours
• Hormones in relation to urinary tract
• Congenital abnormalities

Neurophysiology

• Autonomic nervous system and neurotransmitters
• Neuromodulation; sacral nerve and posterior tibial nerve stimulation
• Regulation of micturition reflex

Pathophysiology including pelvic organ prolapse, bladder outlet obstruction and anatomical anomalies

• Risk factors
• Pathophysiology, including:
  • detrusor sphincter dyssynergia
  • neurogenic detrusor overactivity
  • spinal injury
  • bladder diverticula
  • allergy
  • encopresis and constipation as associated conditions
  • organ prolapse
  • outlet obstruction
  • cancer
  • multiple sclerosis
  • stroke
  • dementia

Pharmacology

• Medications potentially affecting the bladder
• The use of antibiotic prophylaxis
• Botulinum neurotoxin
• Antimuscarinics
• Serotonin and noradrenalin reuptake inhibitors
• Antidepressants
• Antihypertensives
• Female sex hormones

Activities

• Attend urology clinics and discuss your experiences with your training supervisor.
• Identify a patient with urological symptoms and, with permission, follow the progress of the patient from the initial consultation through investigations and follow-up appointment, and reflect on your learning from this process.
• Reflect on your experience of undertaking calibration and maintenance routines for Urodynamic Science and critically evaluate the equipment management systems in the department and how these contribute to patient safety and service delivery.
• Take part in a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with urological disorders.