title: Patterns and predictors of urodynamics use in the United States.
abstract: OBJECTIVE
  Due to the paucity of data on urodynamics on the national level, we assessed the use of urodynamics in a large sample of individuals in the United States and identified predictors of increased complexity of urodynamic procedures.
  
  
  METHODS
  Using administrative health care claims for adults enrolled in private insurance plans in the United States from 2002 to 2007, we identified those who underwent cystometrogram and abstracted relevant demographic and clinical data. We used logistic regression to identify predictors of higher urodynamic complexity over basic cystometrogram, specifically cystometrogram plus pressure flow study and videourodynamics.
  
  
  RESULTS
  We identified 16,574 urodynamic studies, of which 23% were cystometrograms, 71% were cystometrograms plus pressure flow studies and 6% were videourodynamics. Stress incontinence was the most common clinical condition for all studies (33.7%), cystometrogram (30.8%), cystometrogram plus pressure flow study (35.4%) and videourodynamics (24.4%). Urologists performed 59.8% of all urodynamics and gynecologists performed 35.5%. Providers with 14 or more urodynamic studies during the study period performed 75% of all urodynamics and were more likely to perform cystometrogram plus pressure flow study and videourodynamics. On regression analysis the most consistent predictors of cystometrogram plus pressure flow study and/or videourodynamics over cystometrogram were specialty (urologist) and the number of urodynamic tests performed by the provider.
  
  
  CONCLUSIONS
  Most urodynamics in this series consisted of cystometrogram plus pressure flow study with stress incontinence the most common diagnosis. However, regardless of diagnosis, urologists and providers who performed more urodynamics were more likely to perform pressure flow study and/or videourodynamics in addition to cystometrogram. Further research is needed to determine whether these differences reflect gaps in the consistency or appropriateness of using urodynamics.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA. william.stuart.reynolds@vanderbilt.edu
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Chris
authors.initials: C
authors.lastname: Saigal
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D014481:United States; D014563:Urodynamics; D014570:Urologic Diseases / Q000175:diagnosis* / Q000503:physiopathology; D014572:Urology