Strategies for improving comfort and satisfaction in adult patients undergoing urodynamic studies: an evidence summary

Abstract

Objective

To systematically review and summarize the best available evidence on improving comfort and satisfaction in adult patients undergoing urodynamic study (UDS), to provide an evidence-based foundation for clinical practice.

Methods

This evidence summary followed the standardized reporting framework of the Fudan University Center for Evidence-Based Nursing (Registration number: ES20259563). Based on the “5S” model of evidence resources, a systematic search was conducted in the following databases: BMJ Best Practice, UpToDate, Guidelines International Network, World Health Organization, National Institute for Health and Care Excellence, MedPulse, European Association of Urology, American College of Obstetricians and Gynecologists, American Urogynecologic Society, Cochrane Library, PubMed, Embase, Web of Science, Sinomed, CNKI, and Wanfang. The search focused on strategies to enhance satisfaction and comfort during UDS in adults. Literature types included clinical decisions, guidelines, expert consensus, evidence summaries, systematic reviews, meta-analyses, randomized controlled trials (RCTs), and qualitative studies, from inception to December 31, 2025. Two researchers independently conducted literature quality assessment, evidence extraction, and synthesis.

Results

A total of 968 records were retrieved, with 21 articles meeting the inclusion criteria after screening, comprising 2 systematic reviews, 1 expert consensus, 15 RCTs, and 3 qualitative studies. From these, 18 evidence items were summarized across four domains: Communication and Information Support, Environmental and Sensory Modulation, Local and Pharmacological Interventions, and Privacy and Dignity Preservation, with 11 classified as Level 1, 6 as Level 3, and 1 as Level 5.

Conclusion

This study systematically integrated the best available evidence for improving comfort and satisfaction during UDS in adults, identifying effective strategies of nursing interventions. These findings provide an evidence-based foundation for implementing standardized, personalized comfort care in clinical practice, enhancing the quality of nursing care, and offer a reference for developing or updating UDS-related guidelines or standards.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-05117-6.

Introduction

Lower urinary tract dysfunction (LUTD) is a common health issue among middle-aged and older adults, with up to 80% of men over 40 experiencing at least one lower urinary tract symptom (LUTS), and an overall LUTS prevalence as high as 79% in adult women [1, 2]. Studies indicate that LUTS is associated with reduced quality of life, higher levels of depression and anxiety, and even decreased work productivity [1, 3–5], highlighting the critical importance of early diagnosis and standardized management of LUTD. Urodynamic study (UDS) is a vital tool for diagnosing LUTD symptoms [6]. Although not always necessary before initiating treatment, it provides key guidance for therapeutic decision-making and outcome evaluation in complex LUTD cases, such as neurogenic bladder [6–8]. In clinical practice, this test is mostly performed by nurses. It involves a series of diagnostic procedures to assess lower urinary tract function during both the filling and voiding phases [9]. However, its invasive nature—involving catheter insertion into the bladder and rectum, bladder filling with fluid, and voiding in a clinical setting—often leads to negative patient experiences such as anxiety, pain, embarrassment, and privacy concerns [10]. Research data [11] showed that 87% of individuals report discomfort during the procedure, 21% describe severe discomfort, 46% find the test embarrassing, and 22% experience moderate to severe anxiety beforehand. These experiences directly impair patient comfort and satisfaction with care.

Patient comfort and satisfaction are central to a positive healthcare experience and a key focus of clinical nursing practice [12, 13]. In the context of UDS, these adverse experiences can trigger a cascade of multidimensional effects. Beyond immediate distress, increased stress levels during UDS may alter bladder capacity and stimulate sympathetic nervous system (SNS) activity, leading to the secretion of antidiuretic hormone, adrenaline, and noradrenaline, which can cause changes in vital signs [14, 15]. This, in turn, may affect diagnostic accuracy and subsequently alter treatment plans following UDS. Furthermore, negative experiences may lead patients to avoid necessary tests, delay diagnosis, and reduce adherence to subsequent treatments, ultimately impacting therapeutic outcomes, as repeated UDS may sometimes be required to monitor disease progression and treatment efficacy [10, 14].

Although numerous studies have explored individual interventions to alleviate discomfort during UDS, such as pre-procedure information provision [16], analgesia [17], or music therapy [18], these have not received sufficient attention or application in clinical practice. In recent years, the volume of related evidence has grown but remains scattered across various publications. This fragmentation hinders the development of standardized, evidence-based clinical practice guidelines. Therefore, this study aimed to systematically search, synthesize, and summarize the best available domestic and international evidence on improving comfort and satisfaction during UDS. Our goal was to identify effective nursing intervention strategies and core components for enhancing comfort and satisfaction, thereby providing evidence-based support for implementing standardized, personalized comfort care in clinical practice.

Methods

This study has been registered on the Fudan University Centre for Evidence-Based Nursing Evidence Summary Registry (Registration number: ES20259563). Clinical trial number: not applicable.

Problem establishment

Our research question was: What strategies can improve patient satisfaction and comfort during urodynamic studies? Accordingly, we used the PIPOST model [19] to formulate the evidence-based question. The population (P) comprised adult patients (aged ≥ 18 years) clinically assessed as requiring UDS. The interventions (I) included environmental adjustments, information support measures, music therapy, aromatherapy, pharmacological therapy, etc. The professionals (P) were doctors, nurses, or technicians qualified to perform UDS. The outcomes (O) included pain, satisfaction, anxiety, embarrassment, and willingness to repeat the test. The setting (S) was UDS clinics, urology wards, or urogynecology wards. The types of evidence (T) were clinical decisions, guidelines, evidence summaries, systematic reviews, meta-analyses, expert consensus statements, RCTs, and qualitative studies.

Evidence retrieval

Following the “5S” evidence pyramid model [20], a top-down search was conducted in BMJ Best Practice, UpToDate, Guidelines International Network (GIN), World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), MedPulse, European Association of Urology (EAU), American College of Obstetricians and Gynecologists (ACOG), American Urogynecologic Society (AUGS), Cochrane Library, PubMed, Embase, Web of Science, Sinomed, CNKI, and Wanfang. Search terms included “urodynamic/uroflow/UDS,” “satisfaction/comfort/anxiety/embarrass/pain,” and “meta-analysis/systematic review/guideline/evidence/practical guidance/expert/consensus/random/qualitative/opinion/statement.” The search period was from database inception to December 31, 2025. The search strategy for datebases is provided in Supplementary Material 1.

Inclusion and exclusion criteria

Inclusion criteria were: (1) Study population: adult patients (≥ 18 years) clinically assessed as requiring UDS; (2) Study topic: involved measures or recommendations to improve satisfaction and comfort during UDS; (3) Language: limited to Chinese and English; (4) Publication type: clinical decisions, guidelines, evidence summaries, systematic reviews, meta-analyses, expert consensus, RCTs, and qualitative studies.

Exclusion criteria were: (1) Full text unavailable; (2) Duplicate publications; (3) Original studies already synthesized by higher-level evidence; (4) Literature without clear recommendations; (5) Low-quality literature.

Literature screening

Two researchers trained in evidence-based nursing (L. Z., C. S.) used EndNote for literature management. EndNote is a reference management software used to organize and store bibliographic references, as well as to automatically format citations and bibliographies in academic manuscripts. For more detailed information, please visit the official website: https://web.endnote.com/. We first removed duplicates. Then, titles, abstracts, and keywords were screened to exclude studies clearly not meeting the inclusion criteria. Finally, the full texts of the remaining articles were retrieved and reassessed. Any disagreements during screening were resolved through discussion with a third researcher (H. S.).

Quality assessment of the literature

Two researchers (L. Z., C. S.) independently assessed the quality of the included literature. Disagreements were resolved through discussion with a third researcher (H. S.). The JBI Critical Appraisal Checklist for Text and Opinion was used for expert consensus, the JBI Critical Appraisal Checklist for Systematic Reviews for systematic reviews, and the JBI Critical Appraisal Checklist for Randomized Controlled Trials for RCTs [21]. Each item in these tools was rated as “Yes,” “No,” or “Unclear.”

Evidence extraction and summary

A structured extraction form (covering details such as author, publication year, country, study population, evidence description, source reference, etc.) was used for the extraction of baseline study characteristics and evidence items. Evidence synthesis followed these principles [20]: (1) Prioritize professional yet clearly articulated evidence; (2) Logically merge complementary evidence; (3) For conflicting evidence, follow the “5S” evidence pyramid model in a top-down manner, giving preference to evidence with a higher level and more recent publication date, with priority given to clinical decisions, followed by evidence summaries, guideline recommendations, systematic reviews, and then primary studies. Among primary studies, preference is given to findings from RCTs, followed by quasi-experimental studies, observational-analytical studies, observationa-descriptive studies, qualitative studies, and finally expert opinion and basic research. (4) Retain original evidence items if content is independent. The results will be presented in tabular form.

The 2014 version of the Joanna Briggs Institute (JBI) evidence pre-grading system [22] was used to classify evidence levels. For quantitative interventional and observational studies, the system categorizes evidence into 5 levels based on study design: Level 1 (RCTs), Level 2 (quasi-experimental studies), Level 3 (observational-analytical studies), Level 4 (observational-descriptive studies), and Level 5 (expert opinion and basic research). For qualitative evidence, a qualitative or mixed‑methods systematic review is classified as Level 1, a qualitative or mixed‑methods synthesis as Level 2, an individual qualitative study as Level 3, a systematic review of expert opinion as Level 4, and expert opinion as Level 5.

Results

Search results

The initial search yielded 968 records. After removing 345 duplicates, 568 were excluded based on title/abstract screening for being clearly off-topic. Full texts of the remaining 55 articles were assessed, leading to the exclusion of 34, resulting in 21 included studies: 2 systematic reviews [14, 23], 1 expert consensus [9], 15 RCTs [15–18, 24–34], and 3 qualitative studies [35–37]. The literature screening flow is shown in Fig. 1. The basic characteristics of included studies are presented in Table 1.

Fig. 1.

Flow chart of literature screening

Table 1.

General characteristics of the included literatures (n = 21)

Included literatures	Year of publication	Country	Database of sources	Population	Type of evidence
Ciam A [14]	2025	Indonesia	Web of Science	Patients undergoing UDS	Systematic review
Rahmana L A [23]	2025	Indonesia	Web of Science	Patients undergoing UDS	Systematic review
Rezvan A [18]	2018	USA	Pubmed	Patients presenting to the division of FPM&RS for UDS	RCT
Stav K [17]	2015	Israel	Web of Science	Men aged 19–88 year undergoing outpatient multichannel UDS	RCT
Escobar AJ [24]	2024	USA	Embase	Male and female patients aged 21–85 year who were scheduled for UDS	RCT
Saberi N [25]	2023	Iran	Pubmed	Women aged 20–80 year who were referred to have a UDS for evaluation of lower urinary tract symptoms	RCT
Kim JW [26]	2018	Korea	Pubmed	Female patients with SUI who underwent UDS	RCT
Kettas Dolek E [15]	2024	Turkey	Web of Science	Adult patients who underwent UDS at the urology outpatient clinic	RCT
Özel BZ [27]	2021	USA	Pubmed	Patients aged 18 years or older undergoing UDS.	RCT
Uberoi P [28]	2020	USA	Pubmed	Patients over 18 years of age undergoing UDS	RCT
Kuang R [29]	2024	USA	Pubmed	Male and female patients over 18 years of age undergoing UDS	RCT
Ozden E [16]	2024	Turkey	Pubmed	Patients over 18 years of age scheduled for UDS	RCT
Degirmentepe RB [30]	2025	Turkey	Embase	Patients with stress urinary incontinence scheduled for UDS	RCT
Şahin M [31]	2025	Turkey	Embase	Patients scheduled for UDS	RCT
Sibal NS [32]	2025	Turkey	Embase	Patients aged 18–20 year who were scheduled for UDS	RCT
Stav K [33]	2016	Israel	Embase	Patients scheduled for UDS	RCT
Warda H [34]	2019	USA	Embase	Patients aged 18 years or older with a history of LUTD, pelvic organ prolapse, and/or urinary incontinence require UDS	RCT
Selman LE [35]	2019	UK	Pubmed	Men with bothersome LUTD seeking further treatment for their symptoms	Qualitative study
Shaw C [36]	2000	England	Pubmed	Patients had undergone UDS within the preceding 12 months	Qualitative study
Milosevic S [37]	2021	UK	Pubmed	Patients with LUTD who had accepted USD	Qualitative study
Rosier PFWM [9]	2017	NewZealand	Web of Science	Adult patients undergoing UDS	Expert consensus

UDS: Urodynamic study; FPM&RS:Female pelvic medicine and reconstructive surgery; SUI: Stress urinary incontinence; LUTD: Lower urinary tract dysfunction

Quality assessment results of the included literature

This review included 2 systematic reviews [14, 23], both published recently in 2025. For the study by Ciam A [14], item 9 was rated “Unclear” and item 10 “No.” For the study by Rahman LA et al. [23], items 9, 10, and 11 were rated “No,” and item 7 was “Unclear.” The quality of both systematic reviews was considered acceptable, and they were included. Details are in Supplementary Table 1.

The review included 15 RCTs [15–18, 24–34]. All studies had at least 7 items rated “Yes,” leading to the assessment that their quality was acceptable. Details are in Supplementary Table 2.

Three qualitative studies [35–37] were included. For all three, assessment item 1 was rated “Unclear” and item 7 “No.” Additionally, for the study by Selman LE et al. [35], item 6 was rated “No.” All other items across the studies were rated “Yes,” indicating overall good quality. Details are in Supplementary Table 3.

One expert consensus [9] was included and received affirmative ratings (“Yes”) on all assessment items, indicating good methodological quality. Details are in Supplementary Table 4.

Summary and description of evidence

From the 21 included studies, we synthesized 18 best evidence items for improving comfort and satisfaction during UDS in adults. These cover four domains: Communication and Information Support, Environmental and Sensory Modulation, Local and Pharmacological Interventions, and Privacy and Dignity Preservation. The evidence comprises 11 (61%) Level 1, 6 (33%) Level 3, and 1 (6%) Level 5 items. Detailed information on these 18 evidence items and the results of the evidence level assessment are presented in Table 2.

Table 2.

Summary of the best evidence on improving comfort and satisfaction during urodynamic study

Category of evidence	Content of evidence	Source of evidence	Evidence level
Communication & Information Support	1. The interpersonal skills, communication and information giving, maintenance of privacy, and the technical skills of the healthcare provider play significant roles in alleviating patient anxiety and embarrassment during UDS. Staff training and guidance in these areas are required. [35, 36]	Two qualitative studies	3
	2. Adequate pre-procedure consultation improves patient satisfaction. A pre-UDS phone call to address questions or concerns can be considered. [34]	One RCT	1c
	3. Providing a standardized, patient-friendly information leaflet before UDS—covering what UDS is, the procedure, its purpose and benefits, duration, patient instructions before/after the test, potential complications, medication instructions, etc.—is recommended. [9, 33, 36]	One RCT, one qualitative study, one expert consensus	1c
	4. Healthcare providers should establish a trusting relationship through a friendly, relaxed, respectful, and professional demeanor during UDS. This includes active listening and maintaining a calm, non-judgmental reaction to unexpected or embarrassing situations. [36, 37]	Two qualitative studies	3
	5. During UDS, healthcare providers should communicate and explain procedures patiently. Post-procedure, results should be discussed with the patient as soon as possible, with the level of detail tailored to the patient’s preference. [35–37]	Three qualitative studies	3
	6. The supplementation of verbal and written explanations with video-based education (providing detailed visual information about urodynamic studies) should be considered, as it more effective in reducing pre-procedure anxiety and increasing satisfaction.[16, 30, 31]	Three RCTs	1c
Environmental & Sensory Modulation	7. Pre-procedure mindfulness therapy can enhance patients’ sense of calm and relaxation and reduce fear.[28, 29]	Two RCTs	1c
	8. Music therapy during UDS, combined with dimming the procedure room lights, helps reduce patient anxiety and embarrassment and increases willingness to repeat the examination. [18, 23]	A systematic review of multiple RCTs and one RCT	1b
	9. The use of lavender aromatherapy during the procedure is suggested to reduce patient anxiety.[15, 27]	Two RCTs	1c
	10. VR technology is recommended as a promising non-pharmacological intervention for reducing anxiety during UDS.[32]	One RCT	1c
Local & Pharmacological Interventions	11. The use of a heating pad as an adjunctive therapy during UDS is suggested. The pad should be placed on the patient’s sacral area, maintained at 40–45 °C for 30 min.[26]	One RCT	1c
	12. Intraurethral liquid paraffin is recommended as a lubricant during UDS, as it significantly reduces urethral pain during catheter insertion. [17]	One RCT	1c
	13. A low-dose, SANO system can be used for analgesia during UDS. The system delivers adjustable concentrations of N2O via a disposable, sealed mask, with the maximum N2O content limited to 50%. [24]	One RCT	1c
	14. While pre-procedure rectal administration of midazolam for analgesia is safe and effective, routine use is not recommended. It is advised for patients with severe pain preventing cooperation and for women with underlying conditions such as painful bladder syndrome.[25]	One RCT	1c
Privacy & Dignity Preservation	15. Installing physical barriers such as screens around the toilet area better protects patient privacy and reduces embarrassment. [36]	A qualitative study	3
	16. Minimize the presence of unnecessary personnel in the examination room. If observation for teaching purposes is required, prior consent must be obtained from the patient in a discreet and respectful manner. [35, 36]	Two qualitative studies	3
	17. Patients should be allowed to choose a comfortable position and posture for uroflowmetry. [9]	One expert consensus	5b
	18. After the procedure, patients should be allowed to get dressed in their own clothes before any follow-up discussion. [35]	One qualitative study	3

UDS: Urodynamic Study; VR: Virtual Reality; SANO: Self-adjusted nitrous oxide

Discussion

Based on 21 studies, this review summarizes comprehensive strategies for improving patient comfort and satisfaction during UDS, encompassing four dimensions: Communication and Information Support, Environmental and Sensory Modulation, Local and Pharmacological Interventions, and Privacy and Dignity Preservation. Together, these strategies form a multi-level, patient-centered clinical support framework.

Communication and information support

Evidence 1 in Table 2 emphasizes the need to strengthen training and guidance for healthcare personnel. Variability in patient experience and factors influencing anxiety and embarrassment—such as staff interpersonal skills, communication and information delivery, privacy protection, and professional competence—suggest that UDS-specific training should encompass these areas, not just technical operation [35, 36]. Meanwhile, standardized communication scripts could be considered for clinical use.

Evidence 2–6 in Table 2 indicate that communication and information support is not a single event but a continuous process before, during, and after the examination. Patients often experience worry and anxiety due to the “unknown” and feeling “out of control.” A friendly, relaxed, respectful, and professional communication style helps establish an equal, trusting relationship, allowing patients to feel at ease and transfer a sense of control over their condition to the healthcare professional, thereby alleviating anxiety [36, 37]. Examples include patiently listening to patient concerns and avoiding overreaction to awkward situations. Clear, patient communication and explanation during the procedure are crucial [35, 37]. Results should be discussed with the patient as soon as possible after the test, with the level of detail tailored to patient preference [35, 36].

Allowing patients a pre-procedure telephone consultation to ask questions or discuss concerns can improve satisfaction and is suitable for patients with scheduled appointments [34]. Providing a standardized UDS information leaflet is recommended by multiple studies [9, 33, 36]. Healthcare providers should offer comprehensive information covering the purpose, benefits, procedure, duration, and precautions of UDS, helping patients fully understand the test and reducing “unknown-related” anxiety. However, developing standardized materials must balance scientific accuracy with patient diversity in literacy and health literacy, aiming for clarity and visual aids. Supplementing brochures with video-based education is more effective in reducing pre-procedural anxiety [16, 30, 31], likely due to the engagement of dual sensory pathways, promoting deeper understanding.

Environmental and sensory modulation

Evidence items 7 to 10 in Table 2 describe the role of environmental and sensory adjustments in reducing UDS-related anxiety. Mindfulness therapy is widely used to treat and alleviate emotional and psychological issues like anxiety and depression [38, 39]. Researchs [28, 29] show that pre-UDS mindfulness intervention can enhance patients’ sense of calm and relaxation and reduce fear, although its effect on reducing anxiety is debated, possibly due to short intervention duration. Studies indicate lavender aromatherapy can reduce patient anxiety levels, lead to a decreasing trend in vital signs maintained within normal range, and significantly increase SpO₂ [15, 27]. This is because linalool, the main component of lavender oil, induces relaxation by affecting GABA receptors in the central nervous system and positively impacts physiological parameters by increasing parasympathetic nervous system (PNS) activity and reducing peripheral muscle resistance [40, 41]. Therefore, nurses are encouraged to use this simple, easy-to-apply, non-invasive method to reduce patient anxiety during UDS. Practitioners of these therapies should ideally have training in their relevant knowledge and application methods. Mindfulness therapy also requires consideration of time and personnel costs.

Music therapy is a simple, feasible intervention with no known adverse effects, primarily working by distracting attention and improving mood. A meta-analysis [23] found that music therapy during UDS significantly reduced patient anxiety and increased their willingness to repeat the procedure. Dim lighting can create a sense of privacy for the patient; combining music with dimmed lights can help reduce feelings of embarrassment [18]. However, intervention timing, personalized music selection, and volume adjustment are key considerations for implementing music therapy, and lighting choices should not hinder the operator’s assessment. Virtual Reality (VR) is a novel distraction tool that blocks external stimuli by engaging sensory modes like auditory, tactile, and visual, thereby diverting attention [42]. During UDS, patients watching pre-recorded 360° nature videos (without audio) experienced significantly reduced anxiety, and most were willing to reuse and recommend VR headsets [32]. Given its ease of use, affordability, and positive patient feedback, VR is recommended as a promising non-pharmacological intervention for reducing UDS anxiety.

Local and pharmacological interventions

Evidence 11–14 in Table 2 summarize local and pharmacological interventions that can reduce pain during UDS. It is well-known that heat therapy can alleviate muscle pain by increasing local blood flow and tissue oxygenation; heat may also stimulate certain brain areas, producing psychosomatic effects [43]. In a study by Kim JW et al. [26], placing a heating pad (40–45 °C for 30 min) on the patient’s sacral region during UDS reduced anxiety, pain, and distress while increasing comfort. This simple, economical method is recommended as adjunctive therapy during UDS. Patients may experience pain during certain examinations or procedures, with lidocaine gel being a commonly used local anesthetic. Interestingly, research showed that lidocaine gel has no significant effect on reducing pain during UDS for either male or female patients [17, 44]. In male UDS, intraurethral instillation of liquid paraffin was more effective than lidocaine gel in reducing urethral pain [17], possibly because the lubricating properties are more important than the anesthetic agent itself. Therefore, intraurethral liquid paraffin is recommended as the lubricant for UDS.

Self-adjusted nitrous oxide (SANO) can reduce patient-reported pain and improve the subjective experience [24]. Patients use a disposable, sealed mask to titrate N₂O concentration, limited to a maximum of 50%—classified as “minimal sedation” by the American Society of Anesthesiologists (ASA), preserving spontaneous respiration and the patient’s ability to provide verbal feedback [45]. Additionally, it does not require an anesthetist’s presence, patient fasting, or arrangements for transportation home [46]. Thus, SANO is a safe and effective means of pain relief and improving procedure tolerance for adults undergoing UDS, though its approval in local clinical settings must be considered. Midazolam is a benzodiazepine with sedative and anxiolytic effects, producing partial antegrade amnesia. It acts rapidly with a short duration and can be administered via various routes (oral, nasal, intravenous) with no severe adverse effects [47]. Studies show that rectal administration of midazolam (0.3 mg/kg, max 15 mg) before UDS reduces pain without significantly affecting vital signs or oxygen saturation [25]. However, since UDS-related pain intensity is mostly mild, routine use is not recommended. It is advised for patients with difficulty cooperating due to pain or those with underlying conditions (e.g., painful bladder syndrome) leading to heightened pain sensitivity.

In addition to the intervention factors discussed above, technical aspects such as measurement systems and catheter types may also influence patient comfort and measurement reliability during UDS. Regarding measurement systems, the ICS standard [9]. recommends water-filled systems(WFS) with external pressure transducers for cystometry and pressure-flow studies. However, air-filled systems(AFS) have been increasingly used in clinical practice in recent years. Kazakov et al. [48], in a prospective comparative study of women with stress urinary incontinence, demonstrated significant differences between AFS and WFS in measuring abdominal pressure, as well as bladder pressure during coughing and Valsalva maneuver (p < 0.05). Wu et al. [49], in a retrospective study, further found that the two systems yielded significantly different readings in maximum urethral pressure, with no linear correlation between the pressure values. These studies indicate that pressure measurements obtained from the two systems are not interchangeable. Notably, however, one RCT [50] demonstrated non-inferiority of AFS to WFS regarding overall urodynamic trace quality, suggesting that both systems are acceptable in terms of graphical readability. Nevertheless, the numerical differences in pressure values should not be overlooked, and the use of AFS was associated with a significantly higher incidence of self-limiting pain, possibly related to the greater stiffness of the catheter. Regarding catheter size, the ICS standard [9] recommends using the thinnest possible double-lumen catheter for routine urodynamic studies, yet evidence suggests that catheter size may be a variable affecting voiding parameters. Richard et al. [51, 52] showed that placement of a 6Fr transurethral double-lumen catheter reduced maximum flow rate (Qmax) by an average of 7.9 mL/s in women (p < 0.001) and by approximately 4 mL/s in men. These findings suggest that healthcare professionals should consider both catheter size and measurement system when interpreting UDS results. Future studies are needed to further evaluate the combined impact of these technical factors on patient comfort and diagnostic accuracy.

Respect and privacy protection

Evidence 15–18 in Table 2 highlight multiple measures for respecting patients and protecting their privacy during UDS. Due to continuous exposure of private areas and voiding in a public setting, patient privacy is severely compromised, leading to embarrassment. Qualitative studies from the patient perspective underscore the high demand for privacy protection, such as installing physical screens around toilet areas, minimizing unnecessary personnel presence, obtaining prior consent for teaching observations, and assisting patients with dressing promptly afterward [35, 36]. Voiding posture can affect uroflow parameters and post-void residual urine (PVR). For men, standing and squatting postures yield higher flow parameters [53]; for women, squatting is associated with significantly higher maximum flow rates and lower PVR [54]. Clinically, some patients with voiding difficulty may be unable to void or experience slow, painful voiding in a sitting position. Therefore, allowing patients to choose their preferred position for uroflowmetry is recommended. This enhances patients’ sense of control, thereby reducing physical discomfort and anxiety, and safeguarding personal dignity.

Limitations

This study has several limitations: (1) It descriptively integrated intervention strategies. Due to limitations of the primary studies, several evidence items(E.g., Evidence10-14) are supported by single publications, and there are no comparative studies of interventions. Therefore, we could not perform quantitative meta-analysis, provide pooled effect estimates, or determine which method is optimal, future multicenter, large-sample studies should be conducted to compare the effectiveness of these strategies. (2) This summary does not include recommendations from high-level evidence sources such as clinical decision support systems or guidelines. This may reflect a historical focus on UDS technical operation over emphasizing patient experience improvement. However, this study can inform the future development or updating of UDS-related guidelines or standards, particularly by providing a basis for incorporating strategies to enhance satisfaction and comfort. (3) This study did not determine the strength of recommendations for the evidence. This requires final judgment under the FAME framework (Feasibility, Appropriateness, Meaningfulness, Effectiveness), considering evidence validity, feasibility, appropriateness, clinical significance, and input from stakeholders including healthcare professionals, patients, and administrators. This will be a key consideration in the evidence translation phase, as implementing some strategies (e.g., the SANO system) in specific clinical contexts may face challenges. Therefore, readers should interpret the findings with caution and consider the local context.

Conclusion

We summarized 18 best evidence for improving satisfaction and comfort during UDS in adults, identifying effective nursing intervention strategies and core components. This provides an evidence-based foundation for implementing standardized, personalized comfort care in clinical practice and enhancing the quality of nursing care, while also offering a reference for developing or updating UDS-related guidelines or standards. As the evidence originates from different countries and regions, healthcare professionals should consider specific clinical contexts and stakeholder perspectives when applying it. Future efforts should focus on designing more rigorous RCTs to further improve evidence quality and conducting implementation research to facilitate the integration of relevant evidence into clinical practice.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

L. Z., L. D., and L. H. were responsible for the study conception and design. L. Z. and C. S. jointly performed the literature search, quality appraisal of the literature, data extraction, and evidence synthesis. S. H. assisted with the quality appraisal of the literature and the literature screening, while F. T. and C. S. contributed to evidence extraction and synthesis. The corresponding authors, L.H. and L.D., provided supervision, critically revised the manuscript, and took overall responsibility for the integrity of the work. L. Z. drafted the main manuscript text. All authors participated in the interpretation of the findings, critically revised the manuscript for important intellectual content, and approved the final version for publication.

Funding information

This study were funded by Science-Health Joint Medical Scientific Research Project of Chongqing (No. 2023MSXM055, 2023DBXM001) and Chongqing Medical University Education and Teaching Reform Research Project (No. JY20250410).The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Human ethics and consent to participate

Not applicable. This study is based on published literature and did not involve human participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.