Invasive urodynamics aim to objectively assess the function of the lower urinary tract and understand its clinical implications. Although professional standards for invasive urodynamics have been repeatedly defined by the International Continence Society (ICS), evidence shows significant variability in the technical quality of urodynamic tests performed worldwide. Poor-quality testing may lead to patients undergoing unnecessary repeat invasive procedures. In this study, we analyzed the technical quality of urodynamic traces from patients referred to our tertiary unit for functional urologic problems.

Patients assessed at our Functional Urology Outpatient Clinic between July 2020 and February 2025 were included. All patients presented with reports of invasive urodynamic tests performed elsewhere. These traces and reports were evaluated using the Bristol UTraQ tool. Patients were also assessed based on their medical history, physical examination, and urodynamic findings. When a clinical conclusion could not be reached to guide further management, a repeat invasive urodynamic study was performed in accordance with ICS Good Urodynamic Practice guidelines.

A total of 66 urodynamic traces from 59 patients were analyzed. The mean age was 42 years (±15.7). Most studies were conducted at university or training hospitals (59/66, 89%).

Pre-filling phase: All traces showed correct pressure scale/axis values. However, 58 traces (87.8%) lacked a visible ‘zero to atmosphere’, and 50 traces (75.7%) lacked a high-quality cough test at the start. In over 30% of cases, physiological pressure curves were not observed in the Pabd, Pves, or Pdet lines.

Filling phase: Cough/Val salva tests were present throughout in 38 traces (57.5%), but of good quality in only 21 (31.8%). Live pressure fluctuations were visible in only 6 (9%). Patient position was recorded in 3 cases (4.5%), and the transducer level was adjusted upon position change in just one trace (1.5%). Sensations were labeled using standard software tags in 47 cases (71.2%). Leaks observed on flow traces were clearly marked in only half of the cases.

Voiding phase: All pressure lines remained visible in 42 traces (63.6%). Permission to void was marked in 32 cases (48.8%). A cough test was present before voiding in 14 (21.1%) and after voiding in only 2 (3%). Qmax was accurately marked in only a few traces.

Our findings demonstrate substantial deficiencies in the technical quality of urodynamic traces referred to a tertiary centre. The most frequent issues included missing zeroing at the start and poor-quality cough tests throughout the study. Additional problems related to patient positioning—likely due to supine testing—were observed. The voiding phase also frequently showed technical errors. These findings emphasize the need for routine quality audits in urodynamics units.

High-quality urodynamic testing is essential for accurate assessment of lower urinary tract function and for appropriate patient management. This study highlights significant technical deficiencies in referred studies, underscoring the need for standardized training and regular audits to maintain quality.