When should video and EMG be added to urodynamics in children with lower urinary tract dysfunction and is this...

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Urodynamic Studies

Background:

• A 2014 ICI-RS Think Tank convened to evaluate the evidence for integrating video imaging and electromyography (EMG) with urodynamics (UDS) in pediatric lower urinary tract dysfunction (LUTD).
• The primary objective was to identify evidence gaps and propose recommendations for clinical and research protocols.
• The current body of evidence supporting the addition of video (X-ray) and EMG to UDS in children is limited and insufficient.

Framework:

• Systematic literature analysis of X-ray (video) and EMG studies combined with UDS in pediatric LUTD.
• Critical review of the technical aspects of these combined diagnostic modalities.
• Assessment of existing standards, which are noted as poor and variable, leading to practice dominated by expert opinion.

Implementation:

• The Think Tank recommended adopting standardized ALARA (As Low As Reasonably Achievable) principles for video-urodynamics in children.
• Standardization of image evaluation and analysis of its association with pressure changes is crucial.
• Standardization and technical improvement of children's pelvic muscle surface EMG technique are necessary.

Implications:

• Further research is required to better evaluate and define the risk-benefit balance of X-ray exposure in pediatric video-urodynamics.
• Standardized diagnostic approaches will enhance the reliability and reproducibility of UDS findings in children.
• Improved technical execution and evaluation of EMG in pediatric UDS can lead to more accurate diagnosis and management of LUTD.