Comprehensive Urodynamic Assessment in the Management of Pediatric Lower Urinary Tract Dysfunction

Background: Lower urinary tract dysfunction (LUTD) affects 17-22% of children globally. While urodynamic studies (UDS) remain the gold standard for diagnosis, tailored approaches optimizing diagnostic resources may improve patient compliance and outcomes. This study evaluates the efficacy of a comprehensive diagnostic algorithm incorporating clinical assessment, invasive uroflowmetry, and complete urodynamic studies in diagnosing and managing pediatric LUTD.

Methods: We conducted a prospective observational study of 33 children (ages 2-12 years) with LUTD symptoms without structural or neurological abnormalities from June 2021 to July 2023. Patients were categorized into Non-LUTD (< 4 years) and LUTD (≥ 4 years) groups based on symptom onset. Assessment included detailed history, physical examination, voiding diaries, ultrasonography, VCUG, cystoscopy, invasive uroflowmetry, and comprehensive UDS. Management strategies were implemented based on accurate urodynamic diagnoses with regular follow-up assessments.

Results: Complete follow-up data was available for all 33 patients (19 males, 14 females). In the Non-LUTD group (n=16), all patients presented with bilateral hydroureteronephrosis and thickened bladder walls. Vesicoureteral reflux (VUR) was identified in 11/16 cases, with varying UDS findings despite similar clinical presentations. The LUTD group (n=17) showed diagnoses of: overactive bladder (41%), detrusor-sphincter dyssynergia (18%), detrusor overactivity (24%), and hypoactive bladder (18%). Invasive uroflowmetry combined with comprehensive UDS provided definitive diagnoses in all cases, with 17.6% of patients showing discrepancies between initial clinical assessment and final urodynamic diagnosis. All patients demonstrated symptomatic improvement with targeted management based on precise urodynamic findings.

Conclusions: A comprehensive approach incorporating detailed clinical assessment, invasive uroflowmetry, and complete urodynamic studies provides precise diagnosis and effective management of pediatric LUTD. While clinical evaluation remains foundational, confirmatory urodynamic assessment enables tailored therapeutic interventions with superior outcomes.

Level of Evidence: III - Prospective observational study with systematic follow-up and objective outcome measures.