Urodynamic studies are essential for diagnosing lower urinary tract dysfunction but are expert-dependent and time-consuming. Artificial intelligence (AI), notably machine learning (ML) and deep learning (DL) may help automate and standardize interpretation, reducing inter-observer variability and improving efficiency. To evaluate the correlation between artificial intelligence (AI) based classification and human expert diagnosis of detrusor overactivity (DO) in cystometry (CMG), with explicit handling of artifacts and quantification of parameters. Retrospective, single-center, observational diagnostic-accuracy (cross-sectional) study with a consecutive cohort of adults who underwent cystometry in 2023, in which AI outputs were compared with a reference standard (three-urologist consensus). We evaluated 517 cystometry (CMG) tracings: 200 used to train AI models and 317 reserved for testing. Two approaches were assessed: (i) image-based CNN-VGG16 deep learning, which achieved 75% accuracy for detecting detrusor overactivity (DO) but did not yield quantitative metrics and (ii) wavelet-based ML (Daubechies transforms), which improved accuracy to 84.2%, with 82.6% specificity and 86.3% sensitivity, while providing detailed contraction descriptors. An Isolation Forest anomaly-detection stage identified and managed artifacts (e.g., coughs, open lines, catheter movement). Integrating signal processing (time-frequency denoising and rule-based thresholds) with AI classification supported robust CMG event recognition, enabling clearer identification of DO, estimation of bladder compliance from DO-free segments, and mitigation of artifacts. Both branches produced classifications in less than 20s per study. Combining algorithmic outputs with expert supervision could deliver practical, faster, and more reproducible urodynamic reporting, while preserving clinical accountability and transparency and generalizability.

Functional and urodynamics outcomes after robot-assisted cystoprostatectomy with intracorporeal neobladder: Impact of the learning curve.

This study aimed to evaluate the performance of an artificial intelligence (AI)-based analysis of uroflowmetry (UFM) curve images, enhanced with customized preprocessing techniques, to improve diagnostic accuracy for bladder outlet obstruction (BOO) and detrusor underactivity (DUA). We retrospectively analyzed 2,579 UFM curve images from patients who underwent urodynamic study (UDS), including 725 normal and 1,854 abnormal cases (736 BOO and 1,387 DUA). A VGG16 convolutional neural network model was developed to perform 3 binary classification tasks: normal versus abnormal, BOO versus non-BOO, and DUA versus non-DUA. To improve model performance, we implemented a preprocessing pipeline consisting of denoising, cropping, axis scaling, and color-coding of clinical parameters such as voided volume and postvoid residual volume (PVR). Model performance was evaluated using 5-fold stratified cross-validation and the area under the receiver operating characteristic curve (AUROC). Abnormal cases demonstrated a lower median maximum flow rate (8.9 mL/sec vs. 14.8 mL/sec), higher PVR (60.0 mL vs. 20.0 mL), and lower voiding efficiency (78.5% vs. 92.5%) than normal cases. Within the abnormal group, the BOO subgroup showed a higher PVR (80.0 mL) than the non-BOO subgroup (30.0 mL). After applying the preprocessing pipeline, model performance improved, with AUROC increasing from 0.807±0.024 to 0.827±0.016 for normal vs. abnormal classification, from 0.749±0.019 to 0.773±0.034 for BOO classification, and from 0.693±0.016 to 0.709±0.031 for DUA classification. AI-based analysis of UFM curve images, enhanced through customized preprocessing, improved diagnostic accuracy in patients with lower urinary tract symptoms, effectively identifying BOO and DUA. This noninvasive method may serve as an adjunct or screening tool to reduce reliance on invasive UDS.

Objective: The current study aimed to develop predictive models based on noninvasive clinical parameters to facilitate the early identification and stratification of patients with suspected bladder outlet dysfunction (BOD), thereby reducing the need for invasive diagnostic procedures. Materials and Methods: This retrospective study included 307 male patients with lower urinary tract symptoms (LUTS) refractory to medical therapy who were enrolled between January 2001 and May 2022. To assess the predictive performance of the model in an independent cohort, the dataset was randomly divided into the training set (70%) for model development and the test set (30%) for external validation. A two-stage modeling approach was adopted: Stage 1 involved detecting BOD, and stage 2 focused on identifying specific BOD subtypes. Backward stepwise logistic regression was conducted for model derivation, with internal validation performed using 5-fold cross-validation repeated 20 times. Clinical nomograms and a clinical decision-making framework were constructed based on the final modeling results. Results: In stage 1, the derived BOD model for detecting suspected BOD incorporated maximum flow rate, voided volume, intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) as predictors. In stage 2, the derived benign prostatic obstruction (BPO) model included post-void residual (PVR), total prostate volume (TPV), and IPP as predictors. We also constructed nomogram to broadly screening BOD by the combination of maximum flow rate, voided volume, IPP, and PUA, a total score of ≥107 yielded the probability of 0.78 to identify BOD of 0.78. Subsequently, by combining PVR, TPV, and IPP, a total score of ≥39 yielded the probability of 0.35 to discriminate BPO. However, the BOD model (0.47) had a relatively low specificity, and the BPO model (0.58) had a lower sensitivity. Thus, these findings should be considered when applying the models in clinical practice. Conclusions: The results of this study revealed that using the clinical non-invasive parameters to create models can only yield a low sensitivity and low specificity for identifying BPO and the other BOD subtype. In patients with LUTS and small to moderate prostate volume, invasive video urodynamic study is still necessary when invasive treatment modality is recommended.

BACKGROUND: Stress urinary incontinence remains a prevalent medical and social issue that significantly reduces women’s quality of life. Despite their high efficacy, synthetic slings are associated with a risk of complications related to limited biocompatibility of materials. Allografts are a promising approach in surgical treatment of stress urinary incontinence because of their high strength, minimal immunogenicity, and reduced risk of postoperative complications. AIM: The work aimed to improve the outcomes of surgical treatment of stress urinary incontinence in women using a combined allogeneic–synthetic suburethral sling. METHODS: The study included 51 female patients with stress urinary incontinence who underwent suburethral loop plasty (TVT-O) using a newly developed combined allogeneic–synthetic sling. The outcomes were evaluated at 1 to 12 months postoperatively using both subjective (validated questionnaires) and objective diagnostic methods (including the cough test, ultrasonography, comprehensive urodynamic studies, and magnetic resonance imaging). RESULTS: The study demonstrated high efficacy and safety of the combined allogeneic–synthetic sling in surgical treatment of stress urinary incontinence. The findings confirmed favorable biomechanical properties of the implant, a significant improvement in patients’ quality of life (ICIQ-SF and PISQ-12 scores), and the absence of erosive complications. Magnetic resonance imaging findings indicated complete biological remodeling of the allogeneic component with the formation of functional connective tissue 12 months postoperatively. CONCLUSION: A combined sling containing a biocompatible allogeneic component (Alloplant) significantly improves surgical treatment outcomes in stress urinary incontinence. Strategic placement of the biological material in the periurethral zone minimizes the risk of rejection and erosive complications, improves functional outcomes (lower risk of dyspareunia and de novo overactive bladder), and promotes physiological tissue remodeling with the formation of a mature connective tissue regenerate within 6–12 months.

Neurogenic lower urinary tract dysfunction (NLUTD) is a major cause of morbidity and reduced quality of life after spinal cord injury (SCI). In pre-clinical research, small and large animal models such as rats, dogs, and minipigs have been used to investigate NLUTD through urodynamic studies (UDS) such as conventional filling cystometry. Although filling cystometry is currently considered the gold standard for bladder monitoring in pre-clinical research, this approach has several well-recognized limitations. The aim of this study was to develop and evaluate the feasibility of an implantable, radiotelemetric system for monitoring bladder pressure in a Yucatan minipig model of SCI. The transmitter was surgically implanted in the dome of the bladder and several UDS experiments were conducted to evaluate the system's effectiveness at measuring pressure compared to conventional UDS equipment. We observed a strong correlation and agreement between the transmural telemetry sensor and the UDS system. There was no significant difference between bladder compliance and baseline bladder pressure between the two sensor systems. However, the telemetry system recorded significantly lower voiding and non-voiding contraction pressure amplitudes as well as lower voiding threshold pressures and detrusor after-contraction measured with the telemetry system. The telemetry system appeared to be a reliable and accurate method for assessing bladder pressure and allowed for an evaluation of urodynamics in a pig model of SCI for several months. The application of this method could enable a more detailed in vivo evaluation of NLUTD after SCI and a better understanding of micturition behavior during natural-filling, ambulatory urodynamics.

A 59-year-old female patient presented with urinary frequency and incontinence. The urodynamic study suggested stress urinary incontinence. Brain MRI scan revealed changes in both cerebral hemispheres and the cerebellar vermis. This case highlights the importance of a thorough medical history inquiry and comprehensive assessment of diseases affecting several systems.

Neurogenic bladder is a frequent complication in newborns with myelomeningocele (MMC), increasing the risk of urinary dysfunction and renal injury. Although urodynamic studies are the standard for evaluation, their invasiveness limits their use in neonates and young infants. Dynamic ultrasound offers a potential non-invasive tool for assessing the morphology and function of the urinary tract in these patients. To evaluate dynamic ultrasound findings in neonates and young infants with MMC compared to healthy controls. This cross-sectional study used dynamic ultrasound to examine the urinary tract characteristics of patients with MMC and controls. The parameters evaluated included bladder wall thickness, bladder capacity, post-void residual volume, detrusor activity, and signs of elevated intravesical pressure, such as urinary leakage, filling of pseudodiverticula, reduction in ureteral emptying, and enlargement of the pelvicalyceal system dimensions during detrusor contractions. Patients with MMC (n=41) had a mean age of 24.9±13.8days old (56% males), while controls (n=45) had a mean age of 32.9±17.5days old (73% males). Compared to healthy controls, MMC patients exhibited significantly higher post-void residual volume and bladder wall thickness, even after adjusting for body weight. Involuntary detrusor contractions were observed in 76% of MMC cases. Newborns with MMC exhibited distinct bladder characteristics on dynamic ultrasound compared to healthy controls, suggesting potential usefulness of dynamic ultrasound for evaluating these patients. However, additional validation is needed because of the examiner-dependent nature of ultrasound, small sample size, and lack of comparison with urodynamic studies.

A Urodynamic Study On The Prevalence And Patterns Of Bladder Dysfunction In Rural Postmenopausal Women With Lower Urinary Tract Symptoms

Urodynamics (UDS) is critical for patients with neurogenic bladder but remains artificial given retrograde filling and voiding around a catheter in an uncomfortable setting. We have developed a wireless device for catheter-free real-time measurement of intravesical pressure during natural filling. Women with neurogenic bladder secondary to multiple sclerosis (MS) may experience discomfort, detrusor overactivity, or inability to urinate while observed during UDS which might belie true voiding patterns. The aim of this study was to test the wireless device in women with neurogenic bladder due to MS. Ten female participants with neurogenic bladder secondary to MS underwent standard UDS, after which the device was inserted and a second UDS study performed. Patients then ambulated with only the device in place for an additional void. There were no significant differences in UDS results, pain or discomfort between the first and second cycle. The device captured 98% of UDS events, including 100% of detrusor overactivity. Post void residual volume after UDS (160 ± 179 mL [Range 0-454]) was significantly greater than after ambulation with the wireless device alone (19 ± 18 mL [Range 0-46]; p = 0.01), demonstrating greater voiding efficiency with the wireless device alone than with the UDS catheter in place. The device was well tolerated without complications, captured urodynamic data with a high degree of fidelity, and demonstrated additional utility in patients with borderline obstruction or inability to urinate while observed who cannot void during standard UDS. This device offers a promising alternative to the critical information provided by UDS in a less-invasive, more physiologic manner.

Background: Lower urinary tract symptoms (LUTS) are major causes of morbidity in men aged 50 years and above. The LUTS causes reduced quality of life with attendant loss of economic activities. Bladder outlet obstruction is an important cause of LUTS. Urodynamic studies is the gold standard for the investigation of men with LUTS, but this is invasive, costly, time consuming and needs expertise to carry out. One of the remodelling that the bladder undergoes in LUTS is change in detrusor muscle / wall thickness (DWT), which can be investigated by ultrasound. LUTS are assessed using International Prostate System Score (IPSS), and the value obtained can be correlated with DWT. This is a sensitive tool in the assessment of men with LUTS. Studies involving correlation of DWT with IPSS are few in the literature and rare in our environment. The aim of this study is to measure DWT among men with LUTS and correlate the results with their IPSS. Subjects and Methods: This study was carried out in Radiology Department of our hospital from December, 2023 to June 2024. Data obtained from the study was entered and analysed using the Statistical Package for Social Sciences (SPSS), Version 20.0. Sociodemographic characteristics, measures of central tendencies and dispersion for continuous numerical variables, paired sample t-test, as well as Pearson correlation tests were used in the analysis. P-value < 0.05 was considered to be statistically significant. Results: The large numbers of participants in the study were between 56 - 65 years (38.1%) with a mean age of 67.2 years. Most of the subject’s have moderate LUTS. There is a positive linear correlation between the Pre-void DWT and IPSS (p-value = 0.035), but not with post-void DWT (p-value = 0.619). Conclusion: There is an increase in pre-void DWT with increase in severity of LUTS.This is a key indicator of severity in patients with LUTS.

Neural behavior during cystometry of children with congenital Zika virus: Pilot study.

To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function. Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group. A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, p = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU. A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction. UMIN000056036.

Pediatric patients with pelvic solid tumors often receive multimodal treatment, but the long-term effects of this treatment on lower urinary tract (LUT) function are not well-described. This prospective cohort study (NCT05818462) investigates the effect of external beam radiation therapy (EBRT) on LUT function by comparing patient-reported outcome measures, non-invasive urodynamic studies, and post-void residuals (PVRs) amongst childhood cancer survivors (CCS). All subjects were CCS greater than 1year off-therapy for a pediatric solid tumor. Subjects were divided into cohorts by whether they had received pelvic EBRT. Research subjects completed the Dysfunctional Voiding Scoring system (DVSS) survey, uroflow testing, and PVR bladder scan. Thirty-two patients enrolled; half received pelvic EBRT (mean 30.0Gy). There was an equal number of patients exposed to alkylators (69%) in each cohort. Radiation cohort was further off therapy (5.3 vs. 4.0years). The pelvic radiation cohort was more likely to have abnormal uroflow patterns (81% vs. 56%, p = 0.12). The flow pattern distribution differed between groups (p = 0.03); the pelvic radiation cohort was more likely to have a "plateau"-shaped curve (44% vs. 6%) and abnormal PVR (odds ratio [OR] 9.0, p = 0.002). Exploratory conditional likelihood ratio models yielded potential associations between pelvic EBRT and LUTD, as well as a potential dose-response. There was no difference in DVSS scores between cohorts. EBRT appears to affect LUT function in CCS who received pelvic EBRT. DVSS does not appear useful as a screening tool in this population. Further study is needed to better appreciate the impact of EBRT on LUT function and develop more accurate screening tools.

Benign prostatic hyperplasia (BPH) frequently leads to bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS) in aging men. Detrusor overactivity (DO) is a common functional consequence of BOO, often persisting even after surgical intervention. Prostatic inflammation (PI) has been implicated in BPH pathogenesis, but its relationship with DO remains unclear. This study aimed to evaluate the association between histologically confirmed PI and DO in men undergoing transurethral resection of the prostate (TURP) for BPH-related BOO. We conducted a prospective, observational study involving 125 men aged ≥50 years with BPH, BOO confirmed by pressure-flow studies, and moderate-to-severe LUTS (IPSS ≥ 7). All patients had received standard medical therapy and were candidates for TURP. Urodynamic testing was performed before and three months after surgery. Based on baseline urodynamic findings, patients were categorized into two groups: those with DO (Group A) and those without (Group B). Resected prostate tissue was examined histologically, and PI was graded using the Irani score. Statistical analysis was performed using SPSS v26, with odds ratios (OR) and 95% confidence intervals (CI) reported. Prostatic inflammation was identified in 78.4% of patients overall and was significantly more prevalent in those with DO (84.9% vs. 69.2%; OR = 2.47, 95% CI: 1.11-5.49, p = 0.02). Inflammation was also more severe in Group A. DO resolved postoperatively in 75.3% of patients, while persistent DO was associated exclusively with moderate-to-severe PI. The odds of persistent DO following TURP were significantly higher in this subgroup (OR = 4.00, 95% CI: 1.33-12.05). Prostatic inflammation is more frequent and severe in men with DO and is associated with its persistence after TURP. These findings suggest that PI contributes to both the pathogenesis and postoperative course of DO, supporting its role as a therapeutic target in BPH-related LUTS management.

Introduction: Benign Prostatic Hyperplasia (BPH) is a common condition in aging men characterized by prostate enlargement that causes bladder outlet obstruction, leading to Lower Urinary Tract Symptoms (LUTS) such as frequency, urgency, weak urine stream, and incomplete bladder emptying. Accurate assessment of urinary obstruction is essential for appropriate management; however, conventional diagnostic tools like pressure-flow studies are invasive and expensive. Therefore, identifying a simple, non-invasive, and cost-effective parameter such as voiding time may provide an alternative diagnostic approach. Aim &amp; Objective: To evaluate the role of voiding time as a uroflowmetric parameter for detecting urinary obstruction in men with LUTS secondary to BPH and to determine its correlation with the severity of obstruction assessed by urodynamic and clinical parameters. Materials &amp; Methods: A cohort of men diagnosed with BPH presenting with LUTS underwent uroflowmetry to record voiding time along with other parameters such as peak urinary flow rate (Qmax). These findings were compared with urodynamic study results and clinical assessments to analyze the correlation between voiding time and the degree of urinary obstruction. Results: The study demonstrated a significant association between prolonged voiding time and increased severity of urinary obstruction. Patients with longer voiding times exhibited reduced Qmax values and higher obstruction grades on urodynamic evaluation. Conclusion: Voiding time shows potential as a simple and practical indicator for detecting urinary obstruction in men with BPH-related LUTS. Its use could facilitate early diagnosis and timely management, improving patient outcomes and quality of life. Larger-scale studies are warranted to further validate its diagnostic utility.

The artificial urinary sphincter (AUS) is currently the gold standard treatment for stress urinary incontinence in men, and it's also a treatment option for women in Europe. UroActive is a new electronic device that offers remotely adjustable settings, including device pressure. This study aims to compare the range of Maximal Urethral Closure Pressures (MUCPs) covered by UroActive with those covered by the current AMS800 in male and female cadavers. Six cadavers (3 males and 3 females) were implanted with an occlusive cuff (OC) positioned around the bulbar urethra in men and around the bladder neck in women. A MUCP measurement was performed for each of the 3 different AMS800 Pressure-Regulating Balloons (PRBs): 51-60, 61-70, and 71-80 cmH2O, that were successively connected to the OC. The AMS800 PRB was then replaced by the UroActive Control Unit (CU), and MUCP measurements were performed at set pressures from 10 to 150 cmH2O. UroActive device remained fully functional (wireless communication, calibration) throughout the study period. UroActive CU achieved MUCPs values that encompassed the entire range observed with the 3 different AMS800 PRBs. A strong positive correlation between set device pressures sent to UroActive CU and MUCPs was noted in both males (r2 = 0.984) and females (r2 = 0.948). The findings suggest that UroActive provides a wide adjustable range of urethral closure pressures, potentially offering an alternative to AMS800 for managing stress urinary incontinence in both men and women. Further clinical studies are necessary to confirm its safety and effectiveness in patients.

ObjectiveThis study was designed to quantitatively analyze time-related parameters in uroflowmetry curve patterns in patients with benign prostatic hyperplasia and bladder outlet obstruction, and to investigate their potential clinical implications.MethodsA total of 63 patients were included in this retrospective, single-center study. The benign prostatic hyperplasia (BPH) with benign prostatic obstruction(BPO) group consisted of 37 patients, while the nromal group included 26 individuals. Urodynamic study traces and clinical data were analyzed based on inclusion and exclusion criteria. Time-related parameters, including: Time to Qmax (T1), The time from Qmax to the end of uroflow (T2), and Uroflow time (T3 = T1 + T2), as well as corresponding ratios, were quantified and compared between the two groups.ResultsSignificant differences were observed in several time-related parameters between the BPH with BPO group and the normal group. There following parameters demonstrated statistically significant differences: T1 [5 (3.25, 7) s vs. 8.5 (6, 11.5) s, p = 0.00], T2 [23 (15, 34.5) s vs. 10 (6.75, 13.25) s, p = 0.00], T3 [30 (20, 40.5) s vs. 19 (14.75, 23.25) s, p = 0.00], T1/T2 [0.20 (0.13, 0.30) vs. 0.89 (0.65, 1.12), p = 0.00], T1/T3 [0.18 ± 0.10 vs. 0.47 ± 0.10, p = 0.00], T2/T3 [0.82 ± 0.10 vs. 0.54 ± 0.09, p = 0.00].The BPH with BOO group exhibited a shorter time to Qmax onset but significantly prolonged overall voiding duration, a pattern that was consistent with the distinctive “comet tail-like” morphology frequently observed in their uroflowmetry curves. Furthermore, several time-related parameters were identified as potential independent risk factors for bladder outlet obstruction index (BOOI).ConclusionThe time-related parameters in uroflowmetry curve patterns in BPH patients with BPO show distinct characteristics compared to the normal group. These findings suggest that such parameters may serve as valuable diagnostic indicators for bladder outlet obstruction, though further studies with larger sample sizes are needed for confirmation.

Are rhythmic bladder contractions affected by fill rate and bladder work in neurogenic bladders.

Urodynamic studies (UDS) are essential diagnostic tools in urology, but their interpretation requires significant expertise and is subject to interobserver variability. Large language models (LLMs) have shown promise in various medical diagnostic applications, yet their utility in automated interpretation of urodynamic parameters remains unexplored. To evaluate the diagnostic performance of large language models in the automated interpretation of urodynamic parameters compared to urologists with different experience levels. We analyzed 320 urodynamic studies from patients with various lower urinary tract conditions. Two large language models (Deepseek-R1 and GPT-4) were employed to interpret the urodynamic data. Their diagnostic accuracy was compared with that of junior and senior urologists. Performance was evaluated using receiver operating characteristic (ROC) curves, area under the curve (AUC), diagnostic accuracy, and the QUEST framework (Quality of information, Understanding and reasoning, Expression style, Safety, and Trustworthiness). This study was designed and reported following the TRIPOD + AI statement for reporting prediction models using machine learning methods. Deepseek-R1 demonstrated the highest diagnostic accuracy (92.50%) among the automated systems, followed by GPT-4 (85.94%), comparable to junior urologists (83.75%) but lower than senior urologists (95.94%). The reference standard was established by consensus of three board-certified urodynamics experts with median 15 years of experience (range 12-22 years). ROC analysis revealed strong performance across different urological conditions, with AUC values ranging from 0.89 to 0.92 for Deepseek-R1, 0.84-0.88 for GPT-4, 0.81-0.84 for junior urologists, and 0.94-0.95 for senior urologists. The QUEST framework evaluation showed that Deepseek-R1 outperformed other systems in information quality, reasoning, expression style, safety, and trustworthiness. Both LLMs demonstrated high clinical utility, with Deepseek-R1 scoring higher in decision support (4.38/5), time efficiency (2.10/5), and educational value (4.20/5) compared to GPT-4. Large language models, particularly Deepseek-R1, demonstrate promising capabilities in the automated interpretation of urodynamic parameters, with performance exceeding that of junior urologists and approaching senior urologists. These findings suggest potential applications in clinical decision support, training, and quality assurance in urodynamic practice, which could enhance diagnostic consistency and accessibility of expert-level interpretation. This study is a retrospective analysis of deidentified patient data and did not involve any direct patient contact or intervention. Therefore, ethics approval was waived in accordance with institutional and national guidelines.