200 Section - Current Practices and Barriers to Urodynamic Testing in Adults with Spinal Cord Injury: A Survey of Healthcare Professionals

Urodynamic studies (UDS) are essential for evaluating neurogenic bladder in individuals with spinal cord injury (SCI); however, existing guidelines are not specific to this population. We conducted an online survey to identify barriers, characterize variability in practice, and identify emerging best practices for SCI UDS, with the goal of informing future SCI-specific guidelines.

 

Design: An anonymous online survey was distributed to healthcare professionals affiliated with the Neurogenic Bladder Research Group in the United States and Canada. Eligible participants were English-speaking clinicians with experience performing UDS in adults with SCI. The 57-item survey covered respondent characteristics, UDS setup and preparation, procedural and safety practices, interpretation and reporting, barriers, and billing.

Results:

Thirty-six healthcare professionals from the United States (75%) and Canada (23%) completed the survey, including urologists (48%), nurses (21%), advanced practice clinicians (17%), physiatrists (7%), and technicians (5%). Over half (51%) reported that adults with SCI comprised more than 25% of their clinical caseload, and most (78%) had moderate to extensive training in SCI-UDS.

Substantial variability was observed across UDS practices. Fluoroscopy use ranged from routine to unavailable, filling rates varied from 10 mL/min to >50 mL/min, and patient positioning differed widely. Pre-procedure practices were inconsistent, with only 39% routinely using checklists, 49% never recommending bowel preparation, and variable antibiotic prophylaxis. Reporting practices lacked standardization, including compliance thresholds, detrusor pressure cutoffs, and documentation of autonomic dysreflexia. Key barriers included staff availability (58%), setup time (50%), staff training (31%), and transfer or equipment challenges (28%). Common pitfalls in UDS interpretation included technical artifacts, procedural variability, and limited training or experience.

Conclusion:

Despite being performed by experienced clinicians, UDS in adults with SCI shows substantial variability in protocols, preparation, reporting, and interpretation. These findings highlight the need for SCI-specific, evidence-informed guidelines to improve safety, consistency, and access to UDS across clinical settings.