The urodynamic study is a diagnostic test used to evaluate the function of the lower urinary tract during the filling and emptying phase of urination. This study aims to replicate the patient's symptoms while measuring physiological parameters related to urination in order to identify the causes of the symptoms and the related pathophysiological processes (1). The study consists of phases that include uroflowmetry, cystometry and flow-pressure study, and has additional tests like electromyography and video urodynamics that are performed in some exceptional cases according to the needs of each patient. Despite it being a very frequent test and with ample bibliography on the subject, there are no flow diagrams that graphically represent the urodynamic study. This is probably due to the complexity of its interpretation, due to the great heterogeneity of its results and sometimes the poor replicability of the data from one examiner to another (even between serial examinations of the same patient) (1). Some of the reasons for this diversity of interpretations include a large amount of terms and the extended number of symptoms and findings that the study can cover depending on the urodynamic question. 

We propose this mental schema to visually illustrate the process of the study, how it is carried out, how to organize the information, show the possible results of each part of the study, and how the different variables are correlated. Considering that mind mapping has been seen to be an innovative and effective method to remember information, our intention is to create a new teaching method for urodynamics that is not only through reading (2). By means of a flowchart, we intend to facilitate and complement the learning process of doctors in training by providing them with an easily accessible, structured and organized visual tool that avoids the omission of necessary parameters when performing the urodynamic study, showing reports that are as standardized and complete as possible.

The flowcharts were created using the diagramming software draw.io, while the theoretical concepts and terminology were drawn from the latest ICS 2023 good practice consensus.   When no standard definition was found, we considered the use of hand-drawn visual graphic representations through the GoodNotes application to show some examples. We created the flowcharts using the diagramming software draw.io, For better visual organization, we divided all the information regarding the urodynamic study into four diagrams. The first diagram is introductory since it presents general information. The other three diagrams are divided into: uroflowmetry, cystometry, and pressure flow. The diagrams were made based on the general considerations regarding the graphic design of information and procedures, according to the book "the basics of process mapping" (3), emphasizing the correct use of box shape, bullets, connectors, number of words, and organization of events. An attached glossary was created so that the reader understands the layout of the diagram as well as the abbreviations and color or shape code used. In order not to make the information too dense in content, we decided to avoid topics such as the type of catheters, the medium with which the bladder is filled, as well as the indications and interpretations of electromyography and video urodynamics. These topics will be addressed in future work.

The diagrams show structured and clear information illustrating each of the phases of the urodynamic study, with basic concepts that any examiner or physician in training should know, including parameters, mathematical formulas and possible outcomes according to the results obtained. Besides the general definitions and abbreviations, different colors were used to emphasize terms, mathematical formulas or conclusions, favoring the search for specific concepts and ideas within the diagrams. Additional information or parameters that represent an immediate risk to the patient were represented in star-shaped boxes, due to the importance of the concept and its impact when making medical decisions in the long and medium term. Each flowchart allows the operator or medical professional to follow the test while drawing conclusions, facilitating communication between operators, as well as collecting important values and their possible interpretations.

After the literature search and the development of the drafts, diagrams of the different stages of urodynamics were generated (Figure 1 and 2).

The urodynamic study is a useful diagnostic test to diagnose lower urinary tract dysfunction, with a high level of complexity and a variety of interpretations and heterogeneous results. Therefore, it is necessary to start to schematize the procedure and parameters by developing tools that facilitate physicians' learning. We hope that this visual tool, based on the latest ICS guidelines, makes easier the understanding of the different phases of the urodynamic study and also the correlation between variables and their possible outcomes according to the results found. We aim to improve the training of the medical and nursing staff, facilitating the understanding of urology and awakening the interest of trainees in this area.  In the future, visual models like this can be developed to improve patient education. Finally, creating a mind map can also help identify areas where further information or clarification is needed, encouraging the development of research projects in this area.

ICS standards 2023 [Internet]. ICS. [cited 2023 Mar 30]. Available from: https://www.ics.org/members/shop/icsstandards2023
Damelio R. Chapter 6. Flowchart. In: The Basics of Process Mapping. 2nd ed. 2011. p. 93–104.
Abraham SB, Kalyanasundaram M, Ramachandran D, Jayaseelan V, Bazroy J, Singh Z, et al. Effectiveness of mind mapping technique in information retrieval among medical college students in Puducherry-A Pilot Study. Indian Journal of Community Medicine. 2017Mar;42(1):19.

Continence 7S1 (2023) 100924
DOI: 10.1016/j.cont.2023.100924