Anne G Dudley1, Mark C Adams2, John W Brock2, Douglass B Clayton2, David B Joseph3, Chester J Koh4, Paul A Merguerian5, John C Pope2, Jonathan C Routh6, John C Thomas2, Duong D Tu4, M Chad Wallis7, John S Wiener6, Elizabeth B Yerkes8, Chelsea J Lauderdale2, Chevis N Shannon9, Stacy T Tanaka2. 1. Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: annedudleymd@gmail.com. 2. Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. 3. Department of Urology, University of Alabama Birmingham, Children's of Alabama, Birmingham, Alabama. 4. Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, Texas. 5. Division of Urology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington. 6. Division of Urology, Duke University School of Medicine, Durham, North Carolina. 7. Division of Urology, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah. 8. Division of Urology, Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 9. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Abstract
PURPOSE: Urodynamic findings often guide treatment for neuropathic bladder and are reported as objective data points in multi-institutional trials. However, urodynamic interpretation can be variable. In a pilot study pediatric urologists interpreting videourodynamics exhibited only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. MATERIALS AND METHODS: We developed an anonymous electronic survey that contained 20 scenarios, each with a brief patient history, 1 urodynamic tracing and fluoroscopic imagery. All videourodynamics were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from Centers for Disease Control and Prevention Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported, with Fleiss kappa 1.00 corresponding to perfect agreement. RESULTS: The survey was completed by 14 pediatric urologists at 7 institutions. Substantial agreement was seen for assessment of fluoroscopic bladder shape (Fleiss kappa 0.73), while moderate agreement was observed for assessment of bladder safety, end filling detrusor pressure and bladder capacity (Fleiss kappa 0.50, 0.56 and 0.54, respectively). Fair agreement was seen for electromyographic synergy and presence of detrusor overactivity (Fleiss kappa 0.21 and 0.35, respectively). CONCLUSIONS: Experienced pediatric urologists demonstrate variability during interpretation of videourodynamic tracings. Subjectivity of assessment of electromyographic activity and detrusor overactivity was confirmed in this expanded study. Future work to improve the reliability of videourodynamic interpretation would improve the quality of clinical care and the quality of multi-institutional studies that use urodynamic data points as outcomes.
PURPOSE: Urodynamic findings often guide treatment for neuropathic bladder and are reported as objective data points in multi-institutional trials. However, urodynamic interpretation can be variable. In a pilot study pediatric urologists interpreting videourodynamics exhibited only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. MATERIALS AND METHODS: We developed an anonymous electronic survey that contained 20 scenarios, each with a brief patient history, 1 urodynamic tracing and fluoroscopic imagery. All videourodynamics were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from Centers for Disease Control and Prevention Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported, with Fleiss kappa 1.00 corresponding to perfect agreement. RESULTS: The survey was completed by 14 pediatric urologists at 7 institutions. Substantial agreement was seen for assessment of fluoroscopic bladder shape (Fleiss kappa 0.73), while moderate agreement was observed for assessment of bladder safety, end filling detrusor pressure and bladder capacity (Fleiss kappa 0.50, 0.56 and 0.54, respectively). Fair agreement was seen for electromyographic synergy and presence of detrusor overactivity (Fleiss kappa 0.21 and 0.35, respectively). CONCLUSIONS: Experienced pediatric urologists demonstrate variability during interpretation of videourodynamic tracings. Subjectivity of assessment of electromyographic activity and detrusor overactivity was confirmed in this expanded study. Future work to improve the reliability of videourodynamic interpretation would improve the quality of clinical care and the quality of multi-institutional studies that use urodynamic data points as outcomes.
Authors: Kevin T Hobbs; Nathaniel Choe; Leonid I Aksenov; Lourdes Reyes; Wilkins Aquino; Jonathan C Routh; James A Hokanson Journal: Urology Date: 2021-10-29 Impact factor: 2.649
Authors: Ahmed Abdelhalim; Abdelwahab Hashem; Ebrahim E Abouelenein; Ahmed M Atwa; Mohamed Soltan; Ashraf T Hafez; Mohamed S Dawaba; Tamer E Helmy Journal: Int Braz J Urol Date: 2022 May-Jun Impact factor: 3.050