Bristol Urological Institute, Southmead Hospital, Bristol, UK.
Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.
Neurourol Urodyn. 2020 Apr;39(4):1170-1177. doi: 10.1002/nau.24337. Epub 2020 Mar 18.
The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice.
Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized.
Seven out of twenty-five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure-flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%).
Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.
国际尿控协会（ICS）已经对尿流率和尿动力学检查的质量控制和解读进行了标准化。我们根据尿动力学设备和实践的 ICS 标准，评估了来自两个大型男性下尿路症状（UPSTREAM 和 UNBLOCS）研究的轨迹。
在医院现场随机选择 10%的尿流率和尿动力学轨迹。从 ICS 尿动力学实践基础检查表中设计了一个数据捕获模板。两名经过培训的盲评估员提取数据，由第三名评估员进行仲裁。仔细审查了部门校准检查和设备维护的记录。
25 个部门中有 7 个（28%）部门没有报告校准检查。有 4 个（16%）站点无法提供年度服务记录。在 296 个尿流率轨迹中的 32 个（10.8%）中，结果受到伪影的影响。审查了 110 个尿动力学研究轨迹；在 11 个记录中（10%），关键压力轨迹未完全显示。在 30 个（27.2%）中，参考零点未设置为大气压。休息压力在预期范围之外的有 36 个（32.7%）。在 18 个轨迹中观察到压力漂移（16.4%）。在压力-流量研究开始时，15 个（13.6%）漏尿时未获得许可。71.2%的人在排尿后进行了咳嗽测试，但咳嗽尖峰的结果差异显著，为 16.5%。错误诊断膀胱出口梗阻（BOO）的情况有 6 例（5.5%）。
BOO 的错误诊断是一种严重的解释错误，因为它可能导致不必要的手术。还发现了其他标准化、测试和解释方面的错误，其不良影响的风险较低。服务记录的记录不一致意味着设备的准确性不确定。
