The impact of artifact levels on intra- and interobserver agreement in pediatric urodynamic traces.

Introduction: In pediatric urology, urodynamic studies are considered the most reliable method for assessing the function of the lower urinary tract. These evaluations play a particularly important role in guiding treatment decisions for neurogenic bladder conditions.

Objective: The aim of this study is to assess the impact of artifacts on the interobserver and intraobserver agreement in the interpretation of pediatric urodynamic traces.

Methods: Two pediatric urology experts, each with a broad spectrum of clinical expertise, conducted a thorough retrospective analysis of the urodynamic tracings. This evaluation was independently performed by the specialists on two separate occasions, with a three-month interval between sessions. The patients were categorized into three groups based on the quality of their recordings: Group 1: No artifacts (n = 30), Group 2: 1-5 artifacts (n = 30), Group 3: More than 5 artifacts (n = 30).

Results: A total of 90 patients were included in our study, with each group comprising 30 participants. Observer 1's initial and fourth-month measurements by groups, a statistically significant difference was found between the initial MDP measurement values of the cases according to the groups (p = 0.012). High interobserver agreement was observed for EBC, CBC, MDP, and Q max variables across all groups (p < 0.001 for each comparison). In intra-observer agreement for qualitative assessments (compliance, detrusor function, character of overactivity, and DSD), Observer 2 demonstrated lower agreement in groups 2 and 3. Group 3, which had urodynamics with a lot of artifacts, was the group with the lowest agreement values.

Discussion: Few studies in the literature assess the intra- and interobserver agreement of urodynamic studies, with reported variations. Venhola et al. and Zimmern et al. found inconsistent interpretations among observers. Quantitative assessments showed higher reliability than qualitative ones. Our study aligns with these findings, indicating variability due to artifacts and differing interpretations of detrusor overactivity.

Conclusion: Artifacts significantly impact interobserver and intraobserver agreement in pediatric urodynamic studies. While quantitative parameters showed higher agreement, particularly in recordings with fewer artifacts, the presence of numerous artifacts in Group 3 led to decreased consistency in evaluations.

Type of study: Retrospective observational study.