Video Urodynamics Research Articles

Prediction Value of Bladder Deformity Index for Upper Urinary Tract Damage in Patients With Neurogenic Bladder.

This study aimed to assess the predictive value of the Bladder Deformity Index (BDI) in determining upper urinary tract (UUT) damage among patients with neurogenic bladder (NB). Clinical data of 132 NB patients admitted to the China Rehabilitation Research Center between January 2018 and December 2023 were retrospectively analyzed. Patients were categorized into UUT damage and normal UUT function groups based on the MRU and ultrasound grading systems for hydronephrosis, patients with the grade greater than or equal to I degree were considered to have UUTD. Patient demographics, biochemical parameters, and video-urodynamics (VUDS) findings were collected, and BDI was calculated. Independent sample t tests were employed to compare general characteristics and VUDS parameters between groups. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive capability of UUT damage. The study comprised 132 patients (86 males and 46 females) with an average NB duration of 7.37 ± 9.37 years (range: 0.2-44 years). UUT damage was present in 40.91% (n = 54) of patients. Significant differences (p < 0.05) were observed between the UUT damage and normal groups in terms of the duration of LUTS (9.98 ± 10.52 vs. 4.83 ± 7.32 years), creatinine levels (135.58 ± 110.51 vs. 57.66 ± 12.26 μmol/L), and BDI (103.28 ± 71.6 vs. 19.23 ± 15.03%). No significant differences were noted in age, bladder volume, or residual urine between the groups (p > 0.05). The AUC for the duration of LUTS, creatinine, and BDI were 0.691, 0.786, and 0.908, respectively, with a BDI Yoden index of 77%. Long-term LUTS, elevated creatinine levels, and high BDI are associated with UUT damage. BDI demonstrates high sensitivity and specificity in diagnosing UUT damage, outperforming creatinine levels and NB duration. Patients with BDI values exceeding 77% are at a heightened risk of UUT damage. BDI facilitates quantitative evaluation of cystography and preliminary evaluation upper and lower urinary tract function in NB patients. Further research is warranted to validate BDI's feasibility in quantifying cystography and diagnosing UUT damage. This study is retrospective and does not require clinical trial registration.

Role of videourodynamics, imaging, and cystoscopy in patients with recurrent urinary tract infections: Should we throw in the kitchen sink?

Purpose:Recurrent urinary tract infection (rUTI) remains a common outpatient problem with discordance and paucity of evidence for management. This study aims to evaluate the role of videourodynamics (VUD), additional imaging, and cystoscopy in the complete workup of these patients. Materials and Methods:A retrospective review was performed on 1421 consecutive patients referred for physician performed VUD. After exclusion criteria, 170 patients were included. Ethics approval was obtained, followed by data collection, and analysis of demographics, symptoms, cystoscopy results, imaging, and VUD parameters. Statistical analyses were performed with IBM SPSS Statistics Version 28. Statistical significance was defined by an alpha level of P ≤0.05. Results:Overall, 117/170 (69%) had identifiable causes of rUTI identified on VUD. There was a statistically significant difference (p<0.001) in identifying a cause in those with voiding symptoms (93/114 = 82%) compared to those without (24/56 = 43%). Gender was not predictive of an identifiable cause on VUD (p=0.47). Neither was a neurogenic history (p=0.11), diabetes (p=0.97), or age (p=0.89). Additional imaging was not diagnostic for rUTI cause. No malignancy was identified on imaging or cystoscopy. Conclusion:In patients with rUTI, VUD may be an important investigative step to find a possible underlying cause, but it is a scarce resource. As VUD has a higher detection rate in patients with voiding symptoms, by first screening for these patients on history, VUD can be used judiciously. Cystoscopy and additional imaging were not as helpful in identifying a target treatment plan for rUTI, when a VUD had already been done.

117 - Role of conventional urodynamics, video urodynamics, and ambulatory urodynamics in young males with lower urinary tract symptoms: An exploratory randomized trial

117 - Role of conventional urodynamics, video urodynamics, and ambulatory urodynamics in young males with lower urinary tract symptoms: An exploratory randomized trial

112 - Videoflow: Exploiting Standard Care Video Urodynamic Imaging for urine flowrate measurements in children

112 - Videoflow: Exploiting Standard Care Video Urodynamic Imaging for urine flowrate measurements in children

Videourodynamics - role, benefits and optimal practice.

Videourodynamics (VUDS) is an advanced diagnostic procedure that simultaneously combines functional and anatomical evaluation of the lower urinary tract. The goal of this synchronous assessment is to promote accurate diagnosis of the aetiology responsible for patient symptoms, improving therapeutic decision-making. Overall, high-quality VUDS is advocated when other tests such as traditional urodynamics might not provide sufficient data to guide therapy, particularly in patients with complex, persistent or recurrent dysfunctions of the lower urinary tract. Additionally, VUDS is often crucial in the follow-up monitoring of many patients with these dysfunctions. A VUDS study is frequently considered a gold standard in patients with neurogenic lower urinary tract dysfunction, female bladder outlet obstruction or congenital anomalies of the lower urinary tract. Nevertheless, this specialized test should be limited to patients in whom VUDS data add value. Particularly, reliable studies comparing the effect of diagnosis with and without imaging on management outcomes are lacking, and no standardized procedures for undertaking VUDS are available. Additionally, patients should be carefully selected for VUDS evaluation, considering the increased cost and risks associated with radiological imaging. In routine practice, clinicians should balance the additional value of synchronous imaging and the enhanced diagnostic precision of VUDS against the limitations of this approach, which mainly include an uncertain effect of VUDS on final treatment outcomes.

Значение видео-уродинамического исследования в выборе метода лечения детей с нейрогенными дисфункциями мочевого пузыря

Video urodynamics is the standard for assessment of the lower urinary tract in children with neurogenic urinary disorders aiming to provide more information about the condition of the lower urinary tract v. retrograde urethrocystography. Video urodynamics parameters are used as possible indicators for choosing various surgical treatment options, however, all work is focused on adult patients, and data for the pediatric cohort were not available as yet. The purpose of this research was the evaluation of the role of video urodynamics and retrograde urethrocystography in the selection of effective conservative and surgical treatment of neurogenic urinary disorders in children. Materials and methods used: 112 patients aged 1,8 to 18 y/o with neurogenic urinary disorders were included in the study, of whom 101 were those who had been proven effectively treated with conservative M-cholinoblockers or had successfully undergone minimally invasive surgery as follows: intradetrusor injection of botulinum toxin (n=21), transurethral correction of VUR (n=17), simultaneous execution of two of these interventions (n=22). Based on the results of video urodynamic and cystographic examination of these patients with the CHAID technique, the classification trees were built in order to evaluate the effective treatment (conservative/surgical). Results: the median age of patients was 9,0 years [7,8-12,0]. The first classification tree containing the parameter “presence of VUR according to the results of retrograde cystography.” The sensitivity of the obtained model for the effectiveness of surgical treatment was 83,3% v. 73,2% for conservative treatment. The accuracy was 79,2%. The ROC-AUC value was 0,783. The second classification tree contained the maximum Pves value according to the results of the video urodynamics, presence of hyperactivity, presence of VUR. The sensitivity of the obtained model for the effectiveness of surgical treatment was 93,3% v. 97,6% for conservative treatment. The accuracy was 95,0%. The ROC-AUC value was 0,972. Comparison of ROC-AUC values by the Delong test revealed statistically significant differences between these binary classification metrics (p&lt;0.001). Conclusion: the parameters of video urodynamics have greater diagnostic accuracy in effective prediction of both conservative and surgical treatment methods compared to the retrograde urethrocystography.

Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction Insights from Canada's first pediatric cohort.

Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM ) as a therapeutic option for children with refractory BBD. Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires. Six patients completed staged implantation at a median age of 10.8 years (range 8.2-18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10-22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0-7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1-49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0-63.6) at six months. SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment's potential, which must be balanced against the high need for revision detected at three years, possibly related to patients' growth and high activity level.

Risk factors of video urodynamics and bladder management for long-term complications in patients with chronic spinal cord injury

This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.

Novel use of contrast enhanced ultrasonography with urodynamics in children: A comparison study to fluoroscopy.

Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (ceVUS) has rarely been reported for use with UDS. This is the first study to compare the imaging characteristics of ceVUS versus fluoro UDS. Children were enrolled for ceVUS UDS who previously underwent fluoro UDS. Demographics, imaging data for ceVUS and fluoro UDS, time between studies, and clinical data between studies were recorded. Changes in clinical status included implantation/cessation of catheterization or anticholinergic medications, leakage between, urinary tract infections, hydronephrosis and neurologic changes. Comparison testing was performed using McNemar's Chi-Squared and Wilcoxon matched-pairs signed rank test. Seventy-five children were recruited. Median time between studies was 1.3 years (IQR 0.9-2.9). There were no differences for bladder shape (p = 0.59), vesicoureteral reflux (p = 0.10), bladder neck (p = 0.59) or urethra (p = 1.0) between studies. In 5 cases, the bladder neck could not be visualized adequately due to layering of the microbubble contrast against urine. Benefits to ceVUS included ability to visualize the exact moment the bladder neck opened. Following exclusion of patients with clinical changes that might affect imaging findings, an analysis of 28 patients demonstrated no differences between the two studies. CeVUS can be used adequately in conjunction with UDS. Limitations to ceVUS include more granular imaging for bladder shape versus fluoro and inability to visualize bladder neck if residual urine is in the bladder, mitigated by bladder emptying. Benefits include ability to visualize the dynamic activity of the bladder neck due to constant imaging with ceVUS.

Outcomes of women diagnosed with primary bladder neck obstruction based on video urodynamic criteria

AbstractObjectiveFunctional and anatomic bladder outlet obstruction (BOO) in women are more prevalent than previously suspected and remain a diagnostic challenge. Several urodynamic diagnostic criteria for female BOO have been proposed, but studies validating the criteria by assessing treatment outcomes are lacking. We sought to correlate video urodynamic (VUD) diagnostic criteria with symptom improvement in women with functional bladder outlet obstruction.MethodsA retrospective cohort study of women diagnosed with primary bladder neck obstruction (PBNO) by VUD criteria who underwent bladder neck incision (BNI) between 2010 and 2022 was performed. Patient demographic, clinical, and urodynamic characteristics were collected before and after treatment and analyzed.ResultsTwenty‐six women with mean age 64.7 years underwent BNI. Nineteen patients (73.1%) were cured, four (15.4%) improved, and three (11.5%) failed. After BNI the mean postoperative Qmax was significantly higher (9.4 vs. 3 mL/s, p = 0.006) and mean postvoid residual (PVR) was significantly lower (102 vs. 514 mL, p ≤ 0.001). Patients who did not require a catheter preoperatively were more likely to be cured than those who did (90% vs. 62.5%, p = 0.03). The PdetQmax of patients that were cured or improved did not differ significantly from those who were not (50.7 cm H2O vs. 32 cm H2O, p = 0.21).ConclusionsThe diagnosis of PBNO by VUD criteria for obstruction correlated with treatment outcomes with success in 88.5% and 56% becoming catheter independent. Successful treatment was independent of preoperative PdetQmax.

Parental perception of contrast enhanced voiding ultrasonography urodynamics vs fluoroscopic urodynamics

Contrast enhanced voiding ultrasonography (ceVUS) has not been widely reported to be used during video urodynamics (UDS). We previously reported on the feasibility of this. In this study, we aimed to understand how parents perceived their child's experience of undergoing ceVUS during UDS compared to fluoroscopic (fluoro) UDS. Children who underwent both fluoro UDS and ceVUS UDS were recruited. Parents were asked to complete a questionnaire to evaluate their experience with both studies. Demographics including gender, age at study, and diagnosis were collected to account for differences in perception. Statistical analysis was performed. 53 patients were included: 31 girls, 22 boys. Diagnoses included myelomeningocele (67.9%), low/tethered cord (13.2%), closed spinal dysraphism (9.4%), posterior urethral valve (1.9%), cloacal anomaly (1.9%), caudal regression (1.9%), myeloschisis (1.9%), and cerebral palsy (1.9%). There was no statistical difference in mean age at fluoro UDS and ceVUS UDS (77.3 months vs 99.7 months respectively, p=0.09). All 53 parents (100%) were satisfied/very satisfied with their ceVUS experience; 48 parents (90.6%) preferred ceVUS, 3 parents (5.7%) preferred fluoro UDS, and 2 (3.8%) were neutral. On average, parents perceived ceVUS to be more comfortable (72.7%) and produce better results (67.4%) than fluoro UDS. The majority felt that both studies allowed the same contact with their child (52.3%) and took the same amount of time (50.0%). However 29.5% felt ceVUS was faster and 34.1% felt ceVUS allowed more contact with their child (Fig.1). 26 parents (49.1%) specifically noted no radiation as the reason why they preferred ceVUS over fluoro. The average age at ceVUS UDS was younger in those who preferred ceVUS UDS compared to those who preferred fluoro UDS (94.6 months vs 180.0 months, p=0.03). The average age at fluoro UDS was younger in those who preferred ceVUS UDS vs fluoro UDS (73.1 months vs 144 months, p=0.03). Gender's influence on preference approached significance (p=0.07); all 3 parents who preferred fluoro UDS had male children. The majority of parents preferred ceVUS over fluoro UDS. ceVUS was perceived to be more comfortable and provide better results. Many parents highlighted no radiation and no fluoroscopic machinery as factors in preference of ceVUS over fluoro. The parents who preferred ceVUS UDS had children who had both studies done at an earlier age compared to the parents who preferred fluoro UDS.

Editorial commentary to clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale

Retrospective reports are valuable, especially when they convey messages about what to do or not to do in the future. In the study by S.F Batie et al. ( 1 Batie S.F. Coco C.T. Braga B.P. Chan Y.Y. Stanasel I. Jacobs M.A. Baker L.A. Peters C.A. Schlomer B.J. Clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale. J Pediatr Urol. 2023 May 5; (S1477-5131 Epub ahead of print. PMID: 37211501): 00203-00206https://doi.org/10.1016/j.jpurol.2023.05.002 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ) the role of video urodynamics (VUDS) in case of isolated fibrolipoma of the filum terminale, is combined with an investigation of the interrater reliability of VUDS as obtained from post hoc assessment performed by 6 pediatric urologists. Their agreement was fair to very good. Most imaging parameters show very good agreement, whereas the agreement about the urodynamic parameters is less satisfactory with the exception of compliance. Clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminaleJournal of Pediatric UrologyPreviewChildren with an isolated fibrolipoma of filum terminale (IFFT) but otherwise normal spinal cord are often evaluated with video urodynamics (VUDS). VUDS interpretation is subjective and can be difficult in young children. These patients may undergo detethering surgery if there is concern for current or future symptomatic tethered cord. Full-Text PDF

A Mathematical Simulation of the Influence a CMG Catheter’s Frequency Response on Urodynamic Diagnosis

Urodynamics comprises urine flow testing, ultrasound estimation of post-void residual, and Cystometry with filling and voiding phases [1]. Cystometry is the concurrent pressure measurement from the bladder and an abdominal control site, with parallel urine flow measurement. Using conventional water filled catheters, pressures are referenced to atmospheric pressure and the physical height of the external pressure transducer. Cystometry facilitates assessment of detrusor strength, and weakness or obstruction in the tract below.&#x0D; Video Urodynamics (VUDS) adds fluoroscopy to these physiological measurements, and allows differential diagnosis of pathology in Stress Urinary Incontinence (SUI) as well as surveillance of upper tract integrity [2]. A cysto-urethrogram is a non-invasive alternative to VUDS, allowing the whole urinary tract to be visualised during micturition. [3] It sacrifices pressure data, but can include a measurement of flow rate [4]

Augmentation Cystoplasty: Experience in the Developing World

ObjectiveTo assess functional outcomes and classify postoperative complications of augmentation cystoplasty by the Clavien-Dindo classification system.MethodsA total of 197 adult patients undergoing augmentation cystoplasty between January 2016 and December 2020 at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), were included in the study after obtaining approval from the ethics review committee. Patients’ records were reviewed for assessment of complications up to 3 months of follow-up. Functional outcomes were assessed by comparing preoperative video urodynamics study (VUDS) findings with follow-up VUDS findings at 1 year. IBM SPSS v23 was used to record and analyze all the complications, treatments, and pre- and postoperative VUDS data.ResultsOf the 197 patients included in this study, 127 (64.5%) were male and 70 (35.5%) were female. The mean age of the patients was 38.4 ± 9.92 years. Eighty-seven patients (44.2%) remained complication-free, 64 patients (32.5%) had grade I-II complications, 44 patients (22.3%) had grade III and IV complications, and only 2 patients (1%) had grade V complications. Stomal stenosis was the most frequent complication, occurring in 14.7% of patients, followed by renal function deterioration and high-grade fever, each noted in 13.7% of patients. Mean preoperative bladder capacity was 144.3 ± 63.09 mL, mean preoperative filling pressure was 43.34 ± 26.92 cm3 H2O, while mean postoperative bladder capacity was 460.83 ± 70.69 mL and mean postoperative filling pressure was 7.47 ± 5.79 cm3 H2O.ConclusionAugmentation cystoplasty can increase bladder capacity and improve bladder function. Because of the potential for complications, it is essential to carefully choose patients for surgery and provide proper preoperative counseling. Additionally, it is crucial to give proactive postoperative care.

Clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale

Children with an isolated fibrolipoma of filum terminale (IFFT) but otherwise normal spinal cord are often evaluated with video urodynamics (VUDS). VUDS interpretation is subjective and can be difficult in young children. These patients may undergo detethering surgery if there is concern for current or future symptomatic tethered cord. We hypothesized that VUDS in children with IFFT would have limited clinical utility regarding decision for or against detethering surgery and VUDS interpretation would have poor interrater reliability. Patients with IFFT who underwent VUDS for from 2009 to 2021 were retrospectively reviewed to evaluate clinical utility of VUDS. 6 pediatric urologists who were blinded to patient clinical characteristics reviewed the VUDS. Gwet's first order agreement coefficient (AC1) with 95% CI was used to assess interrater reliability. 47 patients (24F:23M) were identified. Median age at initial evaluation was 2.8yrs (IQR:1.5-6.8). 24 (51%) patients underwent detethering surgery (Table). VUDS at initial evaluation were interpreted by treating urologist as normal in 4 (8%), reassuring for normal in 39 (81%), or concerning for abnormal in 4 (9%). Based on neurosurgery clinic and operative notes for the 47 patients, VUDS made no change in management in 37 patients (79%), prompted detethering in 3 (6%), was given as reason for observation in 7 (15%), and was normal or reassuring for normal but not documented as a reason for observation in 16 (34%) (Table). Interrater reliability for VUDS interpretation had fair agreement (AC1=0.27) for overall categorization of VUDS and EMG interpretation (AC1=0.34). Moderate agreement was seen for detrusor overactivity interpretation (AC1=0.54) and bladder neck appearance (AC1=0.46). In our cohort, 90% of patients had a normal or reassuring for normal interpretation of VUDS. VUDS interpretation affected clinical course in a minority of patients. There was fair interrater reliability for overall VUDS interpretation and therefore clinical course regarding detethering surgery could vary depending upon interpreting urologist. This fair interrater variability appeared to be related to variability in EMG, bladder neck appearance, and detrusor overactivity interpretation. VUDS affected clinical management in about 20% of our cohort and supported the choice for observation in around 50% of patients. This suggests VUDS does have clinical utility in pediatric patients with IFFT. The overall VUDS interpretation had fair interrater reliability. This suggest VUDS interpretation has limitations in determining normal versus abnormal bladder function in children with IFFT. Neurosurgeons and urologists should be aware of VUDS limitations in this patient population.

Transvaginal Urethrolysis As A Treatment Option For Women With Recurrent Cystitis

Objectives: To demonstrate the outcome of transvaginal urethrolysis as a treatment option for women with recurrent cystitis, which could be caused from voiding problems. In the case of a failure of non-invasive treatment, the surgical procedure to decrease outlet resistance may have a role. Materials and Methods: Between January 2016 and December 2020, women with recurrent cystitis who underwent urethrolysis at Siriraj Hospital were retrospectively reviewed. Only women who were followed-up for more than 6 months were analyzed. Cure was defined by no clinical symptoms of cystitis, no pyuria on urine analysis, and/or negative urine culture during the follow-up period. Results: In total, 52 women underwent transvaginal urethrolysis. The overall cure rate was observed 53.9% (28 cases) at a median follow-up time of 11.9 (6–59) months. Eighteen of the 44 cases (40.9%) who underwent a video urodynamics study showed bladder outlet obstruction, defined as a Solomon–Greenwell bladder outlet obstruction index of more than 5. None of the characteristics or urodynamics parameters showed statistically significant differences between the cure and failure groups. Postoperative urinary incontinence was reported in 14 cases (26.9%) but showed no statistical difference between the cure and failure group (p = 0.748). Conclusion: Bladder outlet obstruction is a common cause of recurrent cystitis. Transvaginal urethrolysis may have a role as treatment for women with recurrent cystitis from voiding dysfunction who have failed non- and less-invasive treatments. Here, the overall cure rate was 53.8%. A factor associated with the cure rate could not be demonstrated in this study.

Voiding Dysfunction Due to Urethral Sphincter Dysfunction Might Be an Early Neurological Presentation of Central Nervous System Disorders in Aged Patients.

To investigate the incidence of central nervous system (CNS) diseases in adult patients with voiding dysfunction and videourodynamics (VUDS) proven urethral sphincter dysfunction. This retrospective analysis reviewed the medical charts of patients aged > 60 years who underwent VUDS for non-prostatic voiding dysfunction from 2006 to 2021. A chart review was performed to search for the occurrence and treatment of CNS diseases after the VUDS examination up to 2022. The diagnosis of CNS disease, such as cerebrovascular accidents (CVA), Parkinson's disease (PD), and dementia, by neurologists was also retrieved from the charts. Based on the VUDS findings, patients were divided into the following subgroups: dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and hypersensitive bladder (HSB) and coordinated sphincter subgroups. The incidence of CVA, PD, and dementia in each subgroup was recorded and compared among them using one-way analysis of variance (ANOVA). A total of 306 patients were included. VUDS examinations revealed DV in 87 patients, PRES in 108, and HSB in 111. Among them, 36 (11.8%) patients had CNS disease, including CVA in 23 (7.5%), PD in 4 (1.3%), and dementia in 9 (2.9%). Among the three subgroups, the DV group had the highest incidence rate of CNS disease (n = 16, 18.4%), followed by PRES (n = 12, 11.1%) and HSB (n = 8, 7.2%). However, no significant difference was noted in the incidence of CNS disease across the three subgroups. Nevertheless, the incidence of CNS disease was higher in patients with DV and PRES than that in the general population. The incidence of CNS diseases was high in patients aged > 60 years with voiding dysfunction due to urethral sphincter dysfunction. Patients with VUDS-confirmed DV had the highest incidence of CNS disease among the three subgroups.

PD06-12 INTER- AND INTRA-RATER VARIABILITY OF VIDEOURODYNAMIC STUDY INTERPRETATION AMONG UROLOGIC SURGEONS FOR PATIENTS WITH SPINA BIFIDA

You have accessJournal of UrologyCME1 Apr 2023PD06-12 INTER- AND INTRA-RATER VARIABILITY OF VIDEOURODYNAMIC STUDY INTERPRETATION AMONG UROLOGIC SURGEONS FOR PATIENTS WITH SPINA BIFIDA Maria Antony, John K. Weaver, Madalyne Martin-Olenski, Joseph Logan, Reiley Broms, David Ostrowski, Jason Van Batavia, Dana A. Weiss, Christopher J. Long, Ariana L. Smith, Jing Huang, Stephen A. Zderic, Yong Fan, and Gregory E. Tasian Maria AntonyMaria Antony More articles by this author , John K. WeaverJohn K. Weaver More articles by this author , Madalyne Martin-OlenskiMadalyne Martin-Olenski More articles by this author , Joseph LoganJoseph Logan More articles by this author , Reiley BromsReiley Broms More articles by this author , David OstrowskiDavid Ostrowski More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Dana A. WeissDana A. Weiss More articles by this author , Christopher J. LongChristopher J. Long More articles by this author , Ariana L. SmithAriana L. Smith More articles by this author , Jing HuangJing Huang More articles by this author , Stephen A. ZdericStephen A. Zderic More articles by this author , Yong FanYong Fan More articles by this author , and Gregory E. TasianGregory E. Tasian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Videourodynamics (VUDS) provides functional insight into bladder storage and micturition, particularly in children with neurogenic bladder who are at risk of upper tract injury. These studies can serve as drivers for both medical and surgical decision-making, as well as intervention escalation. However, VUDS interpretation is at threat of both intra- and inter-observer variability. Efforts exist to improve standardization, but it is unclear the extent to which surgeons’ interpretations vary. In this study, we evaluated variability in interpretation of upper tract deterioration secondary to bladder dysfunction in a sample of children with spina bifida. METHODS: A total of 303 VUDS studies were evaluated from 256 unique patients between 2 months to 28 years of age. An initial pilot study of 10 VUDS studies were assessed by 5 fellowship trained urologists to align on risk stratification criteria of 3 graded categories (mild, moderate, or severe). Criteria considered to assess upper tract deterioration included bladder compliance, elevated detrusor leak point pressure, and detrusor sphincter dyssynergia from pressure volume tracings and fluoroscopy images. Subsequently, 303 VUDS studies were randomized to 5 reviewers such that each study received a minimum of 3 reviews. Intraclass correlation coefficients were used to reliability of average and single raters. Reviewers also reassessed a portion (range: 5-16%) of same studies within 6 months of their first review. Percent agreement was determined for each surgeon between initial and repeat reviews, as well as initial review and group consensus. RESULTS: Among the 303 VUDS studies, single and average raters’ intraclass correlation (ICC) was 0.67(95% CI: 0.62-0.71) and 0.91(95% CI: 0.89-0.92), respectively. At least one reviewer showed disagreement with other reviewers in 37.3% (113/303) of cases. There was a sole case (0.3%, 1/303) in which 3 different risk scores were assigned to the same patient. Among the sample of studies that were reassessed for intrarater reliability, median agreement of a single urologist with their previous risk score was 76.25% (IQR: 68.75-78.525). Median agreement of a single urologist with group consensus was 80.4% (IQR: 75-81.6). CONCLUSIONS: Class reliability trended upwards with raters average compared to a single rater, showing moderate and good reliability respectively. Single rater inter- and intra-rater variation may compound across serial urodynamic evaluation in clinical and research uses of VUDS to evaluate upper tract deterioration. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e160 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Antony More articles by this author John K. Weaver More articles by this author Madalyne Martin-Olenski More articles by this author Joseph Logan More articles by this author Reiley Broms More articles by this author David Ostrowski More articles by this author Jason Van Batavia More articles by this author Dana A. Weiss More articles by this author Christopher J. Long More articles by this author Ariana L. Smith More articles by this author Jing Huang More articles by this author Stephen A. Zderic More articles by this author Yong Fan More articles by this author Gregory E. Tasian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION Xinfei Li, Zhihua Li, Yuke Chen, Yang Yang, Chen Huang, Hongjian Zhu, Liqun Zhou, and Xuesong Li Xinfei LiXinfei Li More articles by this author , Zhihua LiZhihua Li More articles by this author , Yuke ChenYuke Chen More articles by this author , Yang YangYang Yang More articles by this author , Chen HuangChen Huang More articles by this author , Hongjian ZhuHongjian Zhu More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To validate the modified upper urinary tract videourodynamics in reconstructed ureter with still dilation and hydronephrosis, and to explore the significance in guiding subsequent management. METHODS: From December 2018 to November 2021, a total of 137 patients underwent upper urinary tract video urodynamics at the time of nephrostomy removal 3 months after the reconstruction. The urodynamic result was classified into 3 types. Type 1: the pressure remains stable near the baseline throughout the perfusion process, and the reconstructed ureter is well visualized. Type 2: The renal pelvic pressure increases with perfusion, while urography shows the ureteral peristalsis still exists. At the end of the examination, the pressure difference is lower than 15 cmH2O, and the renal pelvis pressure is lower than 22 cmH2O. Type 3: The renal pelvic pressure and pressure difference increase with perfusion and exceed the normal level. At the same time, ureteral peristalsis is weak or absent (Figure 1). RESULTS: The patients were classified as type I in 124 cases, type II in 7 cases, and type III in 6 cases. All patients in type III received further treatment, including regular DJ stent replacement (2 cases), Allium stent (1 case), ureteroscopic balloon dilation (1 case), ureteroneocystostomy (1 case), and ileal ureter (1 case). Patients in type Ⅱ were instructed to avoid holding urine after the removal of nephrostomy and DJ stents. In 124 patients with type I, there was also 1 case receiving balloon dilatation and 4 cases replacing DJ tube. The sensitivity and specificity of the modified upper urinary tract videourodynamics in predicting the need for further treatment were 54.5% and 100% , and the area under curve was 0.747 (p=0.007) (Figure 2). CONCLUSIONS: The modified upper urinary tract videourodynamics can be used to evaluate the dilated upper urinary tract after reconstruction, and the classification has certain guiding significance for further treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e569 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinfei Li More articles by this author Zhihua Li More articles by this author Yuke Chen More articles by this author Yang Yang More articles by this author Chen Huang More articles by this author Hongjian Zhu More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: A systematic review.

This review aims to systematically evaluate the available evidence on the different urodynamic diagnoses of lower urinary tract symptoms (LUTS) in young adult men aged 18-50 years and to summarize the various urodynamic parameters based on these diagnoses. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement and the search was performed in PubMed, Embase, and Cochrane library from inception till September 2021. A total of 295 records were identified using a combination of keywords such as LUTS, urodynamics (UDS), and young males. The review was registered in PROSPERO (CRD42021214045). All the ten studies, which were included in this analysis, categorised the patients into either of the four primary diagnoses after the UDS - primary bladder neck obstruction (PBNO), dysfunctional voiding, detrusor underactivity (DU), or detrusor overactivity. Five of these studies used the conventional UDS, and in the other five a video UDS was performed. The most common abnormality on the conventional UDS was DU with a pooled estimate of 0.24 (95% confidence interval [CI] - 0.104-0.463, I2-95.35, (τ2-1.07). The most common abnormality on the video UDS was PBNO with a pooled estimate of 0.49 (95% CI - 0.413-0.580, I2-66.59, 2-0.09). The point estimates of various UDS parameters were also recorded. A urodynamic diagnosis was possible in 79% and 98% of the young men who underwent a conventional UDS or a video UDS, respectively. However, the men subjected to the conventional UDS and the video UDS had significant differences in their primary urodynamic diagnostic label. These results will help to plan future trials for the evaluation and management of LUTS in young men.