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

Urodynamic studies (UDS) are the gold standard for evaluating pediatric lower urinary tract dysfunction (LUTD). However, previous studies have shown that the interpretation of cystometric findings may vary according to the observer's level of experience and the criteria used for evaluation. This study aimed to investigate interobserver differences in the reporting of cystometric parameters in children with spina bifida.

Patients who underwent UDS between 2020 and 2025 for neurogenic LUTD secondary to spina bifida were retrospectively reviewed. Studies that did not reach 80% agreement for compliance with good urodynamic practice standards were excluded. Detrusor overactivity (DOA) and bladder compliance were independently evaluated by 4 pediatric urologists and 3 urologists experienced in neuro-urology. Agreement was assessed using Fleiss' kappa test.

A total of 100 children, including 53 females and 47 males, were included; the median age was 6.5 (range, 1-17) years. Agreement of at least 80% was reached in 86% of evaluations for DOA and 82% of evaluations for compliance. Based on the ratings of 7 observers, the Fleiss' kappa value was 0.60 for DOA, indicating moderate agreement, and 0.46 for bladder compliance, indicating weak agreement.

This study demonstrated substantial interobserver variation in the interpretation of UDS, even among experienced centers and observers. Because UDS are essential for the diagnosis, treatment, and follow-up of patients with spina bifida, standardized criteria are needed to improve interobserver consistency in this patient group. Multicenter prospective studies involving observers with varying levels of experience are warranted to improve concordance in UDS reporting.