EAUN25 session report: The role and responsibilities of urodynamic nurses

Urodynamic nurses play a key role in assessing and managing lower urinary tract dysfunction. Their responsibilities include performing urodynamic investigations, ensuring accurate measurements and collaborating with physicians and interdisciplinary teams to optimise patient care. The area of their work varies internationally, reflecting differences in healthcare systems and professional regulations.

Urodynamic investigations and their importance

Urodynamic investigations are essential for diagnosing lower urinary tract dysfunction. These tests measure bladder function, replicate symptoms under controlled conditions and provide objective data to guide clinical decisions.

Urodynamics can be categorised as non-invasive and invasive. Non-invasive tests, such as uroflowmetry and electromyography, assess urinary flow and muscle activity without inserting instruments into the body. Invasive procedures, including filling cystometry and pressure-flow studies, use catheters to measure the pressure inside the bladder.

The catheter is inserted into the bladder to fill it with fluid, usually saline or contrast media, and simultaneously measure the pressure inside the bladder. Additionally, there is a catheter placed in the rectum to measure the intra-abdominal pressure. The urodynamic investigation measures how well the bladder, sphincters, and urethra hold and release urine.

Procedure and key considerations

Preliminary assessments include free uroflowmetry, post-void residual measurement and urinalysis. Patients also keep a bladder diary to document voiding habits.

During the intervention, patients are asked to report sensations such as the first sensation of filling, first desire to void and strong desire to void along with additional information such as pain, sweating and discomfort. Every 100 mL of filling, the patient is asked to cough, or controlled suprapubic pressure is applied to the abdomen to check the pressure transmission of the measurement sensors. Continuous plausibility checks are performed to ensure accurate results.

Catheter placement is verified using cough provocation or suprapubic pressure application. Plausibility checks are performed every 100 mL of bladder filling to maintain measurement accuracy. After the urodynamics, results are reviewed, and patients receive post-procedural guidance on fluid intake and infection prevention.

International variations in urodynamic nursing roles

The role of urodynamic nurses differs across countries. In German-speaking regions, they work in specialised clinics, performing tests independently and providing expert advice. In the UK, their role often extends to diagnostic interpretation and treatment recommendations.

Scandinavian countries emphasise interdisciplinary collaboration, with nurses working closely with physiotherapists and general practitioners. In North America, some nurses are authorised to prescribe medications and develop treatment plans. In developing countries, where access to diagnostics is limited, nurses often take on broader responsibilities, using basic tools to assess and manage patients. Unfortunately, there is very limited research on international differences.

Qualifications and skills required

A Registered Nursing qualification or equivalent is required. Clinical expertise in urology, gynaecology, or continence management is preferred. Technical skills include specialised training in urodynamics. Knowledge of medical equipment and software used in urodynamic diagnostics is essential. Effective communication skills are essential for educating and supporting patients during diagnostic procedures, clearly explaining medical concepts and addressing concerns with empathy. Strong analytical skills help interpret test results and collaborate with physicians on treatment decisions.

Continuous professional development is necessary to stay updated on advancements in urodynamic technology and best practices. Participation in training programmes and professional conferences supports high standards of patient care.

Conclusion

Urodynamic nurses are essential in diagnosing and managing lower urinary tract dysfunction. Their work requires technical expertise, patient education, and interdisciplinary collaboration. International differences highlight the need for standardised training and knowledge exchange.

A structured international training programme could enhance diagnostic consistency and professional collaboration. Ensuring that urodynamic nurses receive specialised education and ongoing training is key to maintaining high standards in urodynamic diagnostics and patient care.

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Author: Ms. S. Baumann (CH) – Head of the Nursing Team in the Dept. of Neuro-Urology at Balgrist University Hospital in Zurich (CH). Previously, Nursing Expert in the Dept. of Medicine at the University Children’s Hospital Zurich and Registered Nurse in the same department.