Practice pattern of urologists in the Rocky Mountains region with regard to use of urodynamic studies

Abstract Objectives To evaluate the patterns of urodynamic studies (UDS) use among community urologists. Much controversy exists with regard to the need and indications for UDS in the clinical evaluation of urinary incontinence (UI) and voiding dysfunction (VD). Methods A one-page questionnaire containing 11 questions was mailed to urologists practicing in the Rocky Mountains region. Physicians were asked about (a) their type of practice; (b) the number of patients with UI and VD they see per week; (c) the number of office procedures they perform on these patients; (d) the percentage of patients with UI and VD for whom they use UDS for diagnostic clarification; and (e) the limiting factors to more frequent use of UDS. Results Of the 127 questionnaires mailed, 51 (40%) were returned, and 49 (39%) of these were returned “completely filled out.” No follow-up letter was sent nor was a telephone interview done. Most urologists (n = 38; 76%) indicated they are in private practice, 5 (10%) are in academics, 3 (6%) are in multispeciality groups, 2 (4%) are affiliated with a health maintenance organization (HMO), and 1 is in a hospital-based practice. Twelve (24%) see fewer than 5 UI patients per week, 21 (43%) see 5 to 10 UI patients per week, and 16 (32%) see more than 10 UI patients per week. The respective numbers for VD patients seen per week are 4 (8%), 12 (24%), and 33 (67%). Thirty (61%) and 32 (65%) of respondents use UDS in fewer than 5% of patients seen with UI or VD, respectively. Thirty-seven (76%) use cystoscopy in more than 5% of patients seen with UI or VD. Regarding limiting factors for more frequent use of UDS (of those 35 urologists giving single answers), 60% believed there was a lack of indication and 40% noted that UDS are too time-consuming or not cost-effective (20%), difficult to interpret (5.7%), or that they had no access to such equipment (14%). Conclusions This study shows that the majority of urologists perform cystoscopy more frequently than UDS for diagnostic clarification of patients with UI and VD, and 40% of urologists do not perform UDS for reasons other than lack of indication. These results may indicate a need for more access to, and additional training in, UDS among urologists for management of UI and VD.