Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy.
Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland.
Medicina (Kaunas). 2022 Feb 23;58(3):341. doi: 10.3390/medicina58030341.
Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6-10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16-20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.
尿动力学被认为是评估下尿路功能的金标准。然而，由于其使用减少，目前很难掌握它所需的特定技能和培训。此外，没有研究或数据可用于定义该诊断工具的工作量和学习曲线。因此，我们旨在评估没有先前经验的住院医师正确执行和解释尿动力学的学习曲线，并根据尿动力学结果正确处理和管理盆底功能障碍患者。这项前瞻性研究分析了在顾问监督下进行尿动力学的住院医师的一系列熟练程度参数，包括：程序持续时间、感知难度、顾问干预需求、解释准确性和治疗建议。然后将进行的程序数量分为五组，以评估每个住院医师达到的自主程度（技术和全面管理自主）。 共有 69 名患者接受了由 3 名住院医师进行的尿动力学检查，每位住院医师至少进行了 20 次检查。程序持续时间、感知难度、顾问干预需求、解释准确性以及根据其对临床数据和尿动力学发现的解释提出的管理/治疗假设的适当性与进行的检查数量直接相关。在执行尿流率时达到了执行 6-10 次检查的技术自主，而在执行压力/流量研究的膀胱测压时达到了执行 16-20 次检查的技术自主。后者还对应于完全自主的获得，其中还包括最佳的治疗建议。 我们发现，在几个熟练程度参数方面，尿动力学存在明显的学习曲线。完成学习曲线可能需要 5 次尿流率和 15 次压力/流量研究的膀胱测压。
