Urodynamic patterns in pediatric patients with cognitive developmental disorders: A retrospective descriptive study

Cognitive developmental disorders (CDD) including intellectual disability (ID), cerebral palsy (CP), Down's syndrome (DS), and autism spectrum disorder (ASD) are often associated with lower urinary tract dysfunction. This study aimed to characterize urodynamic (UD) patterns in pediatric patients with CDD and analyze their relationship with clinical variables and treatment outcomes.

A retrospective observational study was conducted including 79 pediatric patients (ages 4-17) with confirmed CDD who underwent comprehensive video urodynamic evaluations between 2009 and 2024 at a tertiary pediatric center. Data analyzed included age, sex, diagnosis, urodynamic parameters (detrusor overactivity, bladder compliance, detrusor-sphincter dyssynergia, bladder sensation), vesicoureteral reflux (VUR), and treatment modalities. Statistical associations between CDD type and UD parameters were examined using chi-square tests (p < 0.05).

The mean age was 9.2 years, with male predominance (70.9%). Diagnoses included CP (38.0%), ID (32.9%), ASD (24.1%), and DS (5.1%). Dysfunctional voiding was the most frequent diagnosis (32.9%), particularly in CP (43.3%) and ASD (36.8%). Detrusor overactivity was common in ID (57.7%) and CP (40.0%) but rare in ASD (5.3%). Detrusor-sphincter dyssynergia was seen in 56.7% of CP and 26.9% of ID patients and absent in ASD. Decreased bladder compliance (<20 ml/cmH₂O) occurred in 90.0% of ID and 57.7% of CP patients but was preserved in ASD. Absent urgency sensation was found in 50.0% of CP and 19.2% of ID patients. VUR was present in 10.5% of ASD and 6.7% of CP patients. Clinical management was most frequent in ID (96.2%) and ASD (94.7%) patients. Clean intermittent catheterization was required in 43.3% of CP and 12.5% of ID cases. Surgical intervention was necessary in 12.7% of patients, mainly in CP (20.0%).

Distinct urodynamic patterns were observed across cognitive developmental disorders. CP patients showed predominantly neurogenic patterns with high rates of detrusor-sphincter dyssynergia and need for invasive management. ID patients exhibited storage-phase dysfunction responsive to medical therapy, while ASD patients showed preserved motor coordination and compliance, suggesting primarily behavioral or sensory dysfunction. Urodynamic studies are crucial for individualized diagnosis and management in children with cognitive developmental disorders.