Urodynamic Science 2

Module details

Title

Urodynamic Science 2

Type

Specialist

Module code

SPS323

Credits

30

Requirement

Compulsory

Aim of this module

This module provides trainees with a specialised body of knowledge that is applied during specialist work based learning in Urodynamic Sciences. This rotation will enable trainees to perform a range of clinical diagnostic procedures undertaken to investigate disorders of the urinary system, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to undertake a range of investigations, 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, explain procedures to patients and gain consent. Trainees will also 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 video urodynamics, urethral pressure profile (UPP) and ambulatory urodynamics, 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 for video urodynamics, UPP and ambulatory urodynamics ready for use.	Action View
# 5	Learning outcome 1,2,3	Competency Obtain a suitably completed request form, greet the patient and check patient identity.	Action View
# 6	Learning outcome 1,2,3	Competency Explain video urodynamics, UPP and ambulatory urodynamics to the patient and address any questions they 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 from patients referred for video urodynamics, UPP and ambulatory urodynamics investigation.	Action View
# 8	Learning outcome 1,2,3	Competency Obtain a clinical history as appropriate from patients referred for video urodynamics, UPP and ambulatory urodynamics.	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 as defined by department protocol for each investigation.	Action View
# 11	Learning outcome 1,2,3	Competency Carry out each investigation (video urodynamics, UPP and ambulatory urodynamics) in patients presenting with previous surgery, neuropathy or lower urinary tract symptoms at a younger adult age.	Action View
# 12	Learning outcome 1,2,3	Competency Safely remove the catheters.	Action View
# 13	Learning outcome 4	Competency Review the results from the 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 the investigation.	Action View

Assessments

You must complete:

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

Set up video urodynamics equipment to national standards	DOPS
Carry out videourodynamics to national standards choosing settings appropriate for patient and recording results	DOPS
Set up ambulatory urodynamics equipment to national standards	DOPS
Carry out ambulatory urodynamics to national standards choosing appropriate settings for patient and record results	DOPS
Set up equipment for urethral pressure profile test to national standards	DOPS
Carry out urethral pressure profile test to national standards and record results	DOPS
Recognise and take account of any features or artefacts present in measurements	DOPS
Interpret and report on urodynamics data with respect to reported symptoms	DOPS
Maintain equipment maintenance record	DOPS
Conduct an infection control assessment appropriate to a piece of equipment	DOPS
Explain clearly the need for videourodynamic measurement and process for the test	OCE
Explain clearly the need for ambulatory urodynamic measurement and process for the test	OCE
Explain clearly the need for urethral pressure profile measurement and process for the test	OCE
Communicate effectively with patient during test for understanding and repetition of symptoms	OCE
reassurance and maintain awareness of patients experience	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. Plan and perform, under appropriate practitioner direction, video urodynamics tests to identify vesico-ureteric reflux, trabeculation, diverticulae and different types of incontinence.
2. Plan and perform ambulatory urodynamic monitoring to investigate patients referred for a range of situations, including indeterminate cystometry or unreproduced symptoms.
3. Plan and perform urethral pressure profile testing, maintaining awareness of the test’s limitations.
4. Interpret the data and produce high-quality reports and images with respect to video urodynamics, urethral pressure profiles and ambulatory urodynamic monitoring, being able to differentiate between artefact and physiological occurrence.
5. Understand the requirements for appropriate support, routine maintenance and calibration procedures on equipment used in video urodynamics, urethral pressure profiles and ambulatory urodynamics.

Learning outcomes

1. Describe the anatomy and function of the lower urinary tract in children.
2. Describe neurogenic bladder dysfunction and explain dysnergia between the bladder and bladder neck or distal sphincter and grades of vesico- ureteric reflux.
3. Describe the pathophysiology of a range of conditions affecting the urinary tract and the appropriate choice of urodynamic investigation (including including ambulatory urodynamics), considering the findings from the history and clinical examination.
4. Explain the effects of neurological conditions on male and female GI, sexual and reproductive function, and the potential impact on the patient.
5. Appreciate the relative importance in the neurogenic bladder of risk to renal function and control of incontinence.
6. Describe the principles of radiation protection and contrast medium usage applied to urodynamic science.
7. Discuss and critically evaluate a range of equipment used in urodynamic science, including video-urodynamics.
8. Interpret the results from video-urodynamics in a range of patients and make recommendations for possible treatment options and follow-up.

Indicative content

Anatomy and physiology

• Structure and function of the spinal cord
• Pelvic floor musculature
• Anal sphincter complex and their innervations
• Sexual and reproductive function
• Knowledge of gastrointestinal tract and likely associated dysfunction
• Indications for leaving post-void residual

Neurophysiology

• Neurological conditions in male and female GI
• Neurophysiology of the urinary tract

Pathology

• Spinal cord injury
• Multiple sclerosis
• Spina bifida
• Stroke
• Head injury
• Parkinson’s disease
• Myelomeningocele and posterior urethral valves
• Bladder diverticula
• Spinal shock
• Autonomic dysreflexia
• Post traumatic syringomyelia
• Hydrocephalus

Pharmacology

• Contrast medium
• Use of prophylactic antibiotics
• Medication potentially affecting the bladder
• Use of antimuscarinics and botulinum toxin in neurological patients

Device design and technology

• Video and ambulatory urodynamics
• Ultrasound
• Principles of radiation protection
• Sterilisation protocols relating to solid-state transducers and air-filled catheters

Patient groups

• Adult female and males
• Paediatric urodynamics
• Neurological patients

Activities

• Attend continence clinics and discuss the impact of continence clinics on the treatment and support of patients with incontinence and approaches to continence, including the role of physiotherapy.
• Work with colleagues from medical physics/radiology and observe the contribution they make with respect to video urodynamics and the implications of IR(ME)R and IRR99.
• Take part in a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with urological disorders.
• Observe the procedure to undertake abdominal catheter insertion via vagina and stoma and discuss the role of this procedure within Urodynamic Science.