Agreement between two uroflowmetry tests in children with lower urinary tract symptoms

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Lower Urinary Tract Symptoms

Background:

• Uroflowmetry is a primary non-invasive test for pediatric lower urinary tract symptoms (LUTS).
• Current International Children's Continence Society (ICCS) guidelines recommend two uroflowmetry tests for LUTS assessment.
• The study evaluates discrepancies between two uroflowmetry tests in children and their clinical impact.

Purpose of the Study:

• To assess the differences between two consecutive uroflowmetry tests in children with LUTS.
• To evaluate the impact of these differences on diagnostic workup and clinical outcomes.
• To compare the reliability of ICCS and SPU classification systems for uroflowmetry curve patterns.

Main Methods:

• Prospective evaluation of 40 children (4-17 years) with LUTS using two uroflowmetry tests and ultrasonography.
• Classification of uroflowmetry curves based on ICCS criteria and SPU (fractionated vs. smooth) criteria.
• Categorization of bladder capacity (high, normal, low) based on voided volume and post-void residual.

Main Results:

• A significant increase in non-bell-shaped curves was observed from the first to the second uroflowmetry test.
• Kappa values indicated fair agreement for ICCS classification (0.349) and substantial agreement for SPU classification (0.714).
• Disagreement was noted in time to Qmax, with variable concordance in bladder capacity categorization (50-68.4%).

Conclusions:

• The SPU classification system demonstrates greater reliability and potentially reduces subjectivity in uroflowmetry interpretation compared to ICCS.
• Despite classification differences, repeating uroflowmetry does not appear to significantly alter the diagnostic workup or clinical outcome for most pediatric LUTS patients.
• A second uroflowmetry test may not be clinically relevant enough to warrant a universal recommendation for all patients.