Urodynamic testing is an important tool in objective evaluation of the lower urinary tract function in patients presenting with bothersome bladder symptoms. Videocystometrogram (VCMG) is one of the widely used urodynamic investigations that combines pressure-flow studies with fluoroscopic images and is commonly used for assessment of complex storage and voiding phase symptoms. The majority of the urodynamic quality control recommendations focus on the quality of recorded traces, calibration and equipment maintenance. While these are undeniably important, the value of a comprehensive report to accompany the urodynamic data is often overlooked. This audit objectively evaluates VCMG reporting standards and consistency across different services and clinicians at one large tertiary urology centre.

We retrospectively reviewed 20 consecutive urodynamics reports from all the clinicians (Radiologists, Radiographers and Clinical Scientists) who according to the hospital’s electronic patient records have performed and reported VCMG investigations in 2020. All reports were scored by two independent assessors against the audit criteria selected following a review of current evidence of best reporting practice in urodynamics and most recent guidelines from the International Continence Society. The scores were aggregated and analysed to establish examples of good practice and identify areas for improvement. We also compared the scores between the clinicians who use an in-house access database for reporting and those who do not, to establish whether such tools could improve the consistency and quality of reporting. A chi-squared test with p-value <0.05 was used to assess statistical significance

A total of 200 reports (20 each from 10 clinicians) were identified on the hospital’s electronic patient record and selected for review. Five of the clinicians routinely used a Microsoft Access database that was developed in-house to facilitate urodynamic report writing, while others preferred to write reports without the tool. The summary of results is listed in Table 1.

While many areas of the reports have demonstrated good practice, a number of consistently weak areas have been established. Limited information was often available about the pre-VCMG uroflow, rarely specifying patient’s urgency, voiding position, and representativeness. The description of the study often omitted the method of stress provocation and representativeness of the filling and voiding phases. Many of the reports audited were missing time-based graphs, and none of the reports had the pressure-flow plots included.
We note that the reporters who did not use the in-house reporting database were less likely to include details about catheterisation, positions during filling and voiding, and description of urethra and bladder neck during filling. Staff who used the reporting database were found more likely to record not only the ICS standard urodynamics report elements that were specifically covered in the database, but most of the other required elements apart from the method of urodynamic stress test.

Our audit demonstrated that clinicians who used the in-house reporting database were significantly more likely to include the required elements into their urodynamic reports than those who wrote their reports without the aid of such tool. The consistency of reporting could be improved further by making changes to the database to make sure it specifically references all the ICS recommended urodynamics report elements.

Continence 7S1 (2023) 100918
DOI: 10.1016/j.cont.2023.100918