Urodynamic Assessment in Pediatric Lower Urinary Tract Dysfunction: Technical Advances in Pediatric Pressure-flow Testing, Sedation Issues, and Normative Data Updates and the Role of Video-urodynamics and AI-based Image Analysis

Abstract Purpose of Review Lower urinary tract dysfunction (LUTD) is common in pediatric patients. Appropriate evaluation includes urodynamic studies (UDS) to characterize dysfunction using International Children’s Continence Society terminology. This review appraises literature on pediatric UDS, focusing on history and advances in pressure flow testing, sedation considerations, updates to normative data, and the role of video UDS and artificial intelligence (AI)-based image analysis. Recent Findings Current recommendations for pediatric lower urinary tract dysfunction include urinary studies such as urinalysis with or without culture and urodynamic testing, using noninvasive techniques including uroflowmetry and invasive catheter-based studies. Although uroflow curve morphology has traditionally been used to assess bladder function, evidence demonstrates poor reproducibility with low inter and intra rater reliability. Consequently, alternative standardized assessment strategies and machine learning (ML) approaches are being investigated. Summary Urodynamic evaluation remains essential in pediatric urinary tract dysfunction, but criteria and special considerations continue to evolve.