Interobserver Agreement of Filling Cystometry Parameters in Children With Neurogenic Lower Urinary Tract Dysfunction

Area of Science:

• Pediatric Urology
• Neuro-urology
• Urodynamics

Background:

• Urodynamic studies (UDS) are essential for diagnosing pediatric lower urinary tract dysfunction (LUTD).
• Previous research indicates variability in cystometric findings interpretation based on observer experience and criteria.
• This variability impacts consistent patient management.

Purpose of the Study:

• To investigate interobserver differences in reporting cystometric parameters from UDS in children with spina bifida.
• To assess the consistency of UDS interpretation among experienced specialists.

Main Methods:

• Retrospective review of UDS in 100 children with neurogenic LUTD due to spina bifida (2020-2025).
• Exclusion of studies lacking 80% agreement with urodynamic practice standards.
• Independent evaluation of detrusor overactivity (DOA) and bladder compliance by 7 experienced urologists; agreement assessed using Fleiss' kappa test.

Main Results:

• Moderate agreement (kappa=0.60) for detrusor overactivity (DOA) and weak agreement (kappa=0.46) for bladder compliance were observed.
• 86% of DOA evaluations and 82% of compliance evaluations reached at least 80% agreement among observers.
• Significant interobserver variation exists even among experienced specialists.

Conclusions:

• Substantial interobserver variation in UDS interpretation was confirmed in children with spina bifida.
• Standardized criteria are necessary to enhance interobserver consistency in UDS reporting for this population.
• Multicenter prospective studies are recommended to improve UDS concordance.