Urology Surgery Audit Form
Audit and assess the quality and outcomes of urological surgical procedures.
Date of Surgery
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient Age
*
Patient Gender
*
Male
Female
Other
Type of Urological Procedure
*
Please Select
Prostatectomy
Nephrectomy
Cystectomy
Ureteroscopy
TURP
Other
Surgical Approach
*
Open
Laparoscopic
Robotic
Endoscopic
Other
Operating Surgeon
*
Duration of Surgery (minutes)
*
Intraoperative Complications
*
None
Bleeding
Injury to surrounding organs
Anesthesia-related
Other
Postoperative Complications
*
None
Infection
Urinary retention
Reoperation
Other
Length of Hospital Stay (days)
*
Audit Quality Assessment
*
Rows
Poor
Fair
Good
Excellent
Preoperative Documentation
1
2
3
4
Surgical Technique
5
6
7
8
Infection Control
9
10
11
12
Postoperative Care
13
14
15
16
Additional Comments or Notes
Submit Audit
Should be Empty: