Quality control is critical in urodynamic testing as pressure and flow measurement errors are common and must be addressed and dealt with before and during the procedure.2 Incompetent urodynamics (UDS) may lead to some patients being refused necessary treatment and others being exposed to therapies from which they will not benefit.  Clinical audit is a component of continuous quality improvement. The study aimed to compare our urodynamic testing to ICS GUP (International Continence Society's Good Urodynamic Practice) standards and to detect quality control issues that might be enhanced. Additionally, we intended to urge other urodynamic centers to do their assessment by delivering straightforward, standardized questionnaires and illustrations as a point of reference.

The urodynamic services were started in January 2021 in this institute. The audit was done retrospectively with patients attending for urodynamic tests from January 2021 to January 2023, according to "Good Urodynamics practice" laid down by ICS. The initial audit was done after 31 cases, a reaudit was done after 129 cases, and again reaudit was done after 200 cases to assess the quality.

We reviewed ICS recommendations and performed an audit for urodynamic testing at our center, improving our urodynamic practice.
These audits showed the improvement of all the parameters in urodynamic testing with the regular audits. The results are summarized in Image 1. ICS standard urodynamics protocol was mentioned in the initial audit in 9% of the cases, which improved to 94% after the third audit. Post initial audit, display of patient position, infused volume, and flow traces improved from 3% to 60%, which further improved to 89-100%. The various factors in the quality of tracings improved from 35% to 95.5%. The flow markers and voided volume results improved from 3% to 95%. Other reporting parameters also improved post-initial audit. The most common complication post urodynamics was fever and dysuria in 2-3% and 5-6 % of cases, respectively.

Image 1 summarizes the outcomes of a pre and post-urodynamics audit. The audit questions and their corresponding results are presented for three different sample sizes: n=31, n=129, and n=200. The audit questions cover various aspects of urodynamic testing, such as ICS standard protocol, display, quality, flow, markers, etc. The table shows improvements in most of the audit outcomes between pre-audit and audit results for all sample sizes. However, there are some aspects where improvements are still needed. Overall, the results suggest that the urodynamic testing process was improved after the audit.

Auditing the urodynamic practice would result in uniformity among all the centers, and it would help maintain a consistent database. This would also help any new urodynamic center to maintain adequate standards laid by ICS. This audit showed the improvement of all the parameters in urodynamic testing with repeated audits.

Moore KC, Emery SJ, Lucas MG. Quality and quantity: an audit of urodynamics practice in relation to newly published National Standards. Neurourol Urodyn. 2011;30(1):38-42. doi:10.1002/nau.20942
Sullivan J, Lewis P, Howell S, Williams T, Shepherd A m., Abrams P. Quality control in urodynamics: a review of urodynamic traces from one centre. BJU Int. 2003;91(3):201-207. doi:10.1046/j.1464-410X.2003.04054.x
Working Group of the United Kingdom Continence Society, Abrams P, Eustice S, et al. United Kingdom Continence Society: Minimum standards for urodynamic studies, 2018. Neurourol Urodyn. 2019;38(2):838-856. doi:10.1002/nau.23909