Neurourology and Urodynamics最新文献

{"title":"Sensing in Sacral Neuromodulation: Objective, Individualized Stimulation Response Thresholds Directly From the Lead.","authors":"Colin Goudelocke, Henry Ruiz, Charles R Powell, David Sheyn, Brian J Linder, Ketul Shah, Gustavo Villegas, Joseph Henderson, Anne G Sammarco, Sarah J Offutt, David U J Keller, Katie C Bittner, Hank Bink, Ivan Merlo, Julia P Slopsema, Lisa Jungbauer Nikolas","doi":"10.1002/nau.70443","DOIUrl":"https://doi.org/10.1002/nau.70443","url":null,"abstract":"<p><strong>Objectives: </strong>Sacral neuromodulation (SNM) therapy today relies on visually observed motor responses (e.g., anal bellows contraction, toe flexion) and subjective patient feedback (pelvic region sensations) to optimize lead placement and perform device programming. Measures of sacral nerve activation used in current practice include motor and sensory thresholds, described as the stimulation amplitudes associated with first observed or reported stimulation responses. This study evaluated the utility of sacral evoked responses (SERs), recorded directly from implanted commercial SNM leads, as objective indicators of sacral nerve activation.</p><p><strong>Materials and methods: </strong>The PEER 2 Cohort 1 study was a multi-center, prospective, clinical feasibility study in female overactive bladder patients undergoing a tined lead evaluation for SNM using InterStim™ SureScan™ MRI leads. An investigational external neurostimulator was used to collect electrophysiological signal recordings directly from the implanted lead (SER recordings), in addition to motor and sensory thresholds at three timepoints: intraoperatively (OR), immediately postoperatively (PO), and at the end of therapy evaluation (Trial End). SER recordings were processed to determine stimulation amplitudes associated with first detectable signal (SER threshold, SERT) and analyzed for comparison with the motor and sensory thresholds.</p><p><strong>Results: </strong>Lead-recorded SERs were reliably detected across subjects and timepoints: OR: 100% (89/89 subjects); PO 98.9% (87/88 subjects); Trial End: 97.7% (86/88 subjects). SERTs demonstrated statistically significant correlation with both motor and sensory thresholds across six bipolar electrode configurations (R = 0.46-0.92; p < 0.001). Compared to sensory thresholds, SERTs were a more sensitive measure of sacral nerve activation, detected at or below sensory thresholds in 57%-84% of subjects. SERTs also exhibited less variability across repeated measurements compared to sensory thresholds (p < 0.001). Replicate SERTs showed no change in 55.9% of subjects, whereas sensory thresholds showed no change in only 20.6% of subjects.</p><p><strong>Conclusions: </strong>The study results demonstrate that SERs recorded from SNM leads are reliably detected, clinically relevant, sensitive, and consistent markers of sacral nerve activation, offering an objective alternative to present-day subjective measures. Integrating lead-sensed SERs may streamline SNM programming and lead placement, introducing a simplified and standardized measure for optimizing and delivering patient-specific SNM therapy.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov NCT05200923. Investigational device. Limited by Federal (U.S.) law to investigational use. The research system and sensing feature are not approved by the FDA or any other regulatory authority and are not for sale in the US or internationally.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on \"Differences Between Men and Women With Urinary Incontinence as They Seek Medical Care\".","authors":"N V L Suvarchala Reddy, Praveen Kumar Annagowni, M Lakshmi Madhuri","doi":"10.1002/nau.70462","DOIUrl":"https://doi.org/10.1002/nau.70462","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Canephron N in Preventing Urinary Tract Infection: A Systematic Review and Meta-Analysis.","authors":"Ezgi Seyhan Ak, Yeliz Çulha, Mehmet Gökhan Çulha","doi":"10.1002/nau.70449","DOIUrl":"https://doi.org/10.1002/nau.70449","url":null,"abstract":"<p><strong>Aim: </strong>Urinary tract infections (UTIs) are among the most common bacterial infections, particularly in women, with significant implications for quality of life and healthcare costs. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Canephron N in preventing UTIs, comparing its effects to antibiotics and assessing its potential as an antibiotic-sparing alternative.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search across multiple databases (Embase, PubMed, Cochrane, Web of Science, and ClinicalTrials.gov) up to July 2025, following PRISMA guidelines. Risk of bias was assessed using Cochrane RoB 2 for RCTs and ROBINS-I for non-randomized studies. Meta-analyses were performed using random-effects models, with outcomes including bacteriuria presence, Acute Cystitis Symptom Scores (ACSS), and adverse events. Heterogeneity was quantified via the I² statistic.</p><p><strong>Results: </strong>From 246 initially identified records, 12 studies (eight RCTs, three observational, one retrospective; n = 3821 patients) were included. Canephron N demonstrated non-inferiority to antibiotics in reducing UTI recurrence (6-month rates: 8.9% vs. 17.8%) and symptom severity (ACSS reduction: -1.9 to -2.3 points). Pooled analyses revealed significant difference in bacteriuria clearance (RR: 1.34, 95% CI: 1.20-1.48, p < 0.0001) and no significant adverse events (RR: 0.90, 95% CI: 0.69-1.18, p = 0.43), though gastrointestinal events were less frequent with Canephron (4.8% vs. 7.1%). Heterogeneity was moderate (I² = 72% for bacteriuria outcomes), attributed to variability in study designs and comparators.</p><p><strong>Conclusion: </strong>Canephron N is an effective and safe alternative to antibiotics for preventing uncomplicated UTIs, with comparable symptom relief and a lower ecological impact.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Pelvic Organ Prolapse and Overactive Bladder: A Systematic Review and Meta-Analysis.","authors":"Lorenzo Vacca, Daniela Caramazza, Michele Pierro, Aniello Foresta, Andrea Lombisani, Anna Fagotti, Alfredo Ercoli, Giuseppe Campagna","doi":"10.1002/nau.70444","DOIUrl":"https://doi.org/10.1002/nau.70444","url":null,"abstract":"<p><strong>Background: </strong>Pelvic organ prolapse (POP) frequently coexists with overactive bladder (OAB) symptoms, yet the impact of surgical correction on OAB outcomes remains incompletely characterized across different surgical approaches.</p><p><strong>Objectives: </strong>To quantify OAB symptom resolution rates following POP surgery, compare outcomes across surgical techniques, evaluate de novo OAB incidence, and identify predictive factors for postoperative OAB persistence or development.</p><p><strong>Search strategy: </strong>Comprehensive search of MEDLINE, Embase, Web of Science, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and LILACS through December 31, 2024, limited to English language articles.</p><p><strong>Selection criteria: </strong>Comparative studies (randomized controlled trials and observational studies) including adult women with symptomatic POP (POP-Q stage ≥II) undergoing surgical correction, reporting validated OAB outcomes with minimum 3-month follow-up.</p><p><strong>Data collection and analysis: </strong>Three independent reviewers extracted data using predefined criteria. Random-effects meta-analyses with Freeman-Tukey double arcsine transformation were performed. Quality assessment employed Cochrane Risk of Bias 2.0, Newcastle-Ottawa Scale, and GRADE methodology.</p><p><strong>Main results: </strong>Twenty-four studies encompassing 7739 women (7095 analyzed) were included. Overall OAB resolution rate was 58.0% (95% CI: 55.9%-60.1%; I² = 83.9%). No significant differences emerged between vaginal, laparoscopic/robotic, or abdominal approaches (p = 0.62), or between mesh-augmented versus native tissue repairs (p = 0.48). Compartment-specific analysis revealed anterior/apical repairs achieved significantly higher resolution (75.8%, 95% CI: 73.2%-78.3%) compared to isolated posterior repairs (28.3%, 95% CI: 20.1%-37.9%; p < 0.001). De novo OAB incidence ranged 0%-14.3%, though reporting was limited to 6 studies.</p><p><strong>Conclusions: </strong>POP surgery resolves preexisting OAB in approximately three-fifths of patients, with anatomical compartment representing the strongest predictor. Anterior/apical prolapse correction offers superior OAB outcomes compared to posterior repair, independent of surgical approach or mesh utilization.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Toilet Training Timing and Prognosis of Nocturnal Enuresis in Children: A Retrospective Study.","authors":"Shota Endo, Hirokazu Ikeda, Yuma Iwanaka, Takahiro Ono, Chisato Oyake, Yuta Onuki, Yoshitaka Watanabe, Masaki Fuyama, Tsuneki Watanabe","doi":"10.1002/nau.70452","DOIUrl":"https://doi.org/10.1002/nau.70452","url":null,"abstract":"<p><strong>Aims: </strong>Toilet training (TT) is a critical developmental milestone with potential implications for lower urinary tract function. However, its association with the prognosis of nocturnal enuresis (NE) remains unclear. We aimed to evaluate whether the timing of TT initiation and completion affects 1-year treatment outcomes in children with NE.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 163 children diagnosed with NE between April 2020 and March 2023. Patients were classified into complete response (CR) and non-CR groups based on 1-year treatment outcomes. Data on TT timing, constipation, and daytime incontinence (DI) were obtained from medical records and a structured questionnaire. Statistical analyses included the chi-square test, Mann-Whitney U test, and multivariate logistic regression.</p><p><strong>Results: </strong>The median age of the cohort was 8 years, and 66.9% of the patients were male. TT was initiated before 3 years of age in 67.5% of patients and completed before 4 years of age in 50.9%. Early TT completion was associated with a significantly lower rate of DI; however, no significant association was observed between TT timing and achievement of CR. In multivariate analysis, neither early TT initiation nor early TT completion independently predicted CR.</p><p><strong>Conclusions: </strong>Although early TT may be associated with a reduced prevalence of DI, TT timing was not significantly associated with CR at 1 year in this cohort. Constipation and DI were associated with lower odds of CR in the exploratory multivariable analysis.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Health and Female Lower Urinary Tract Symptoms: A Systematic Review.","authors":"Kenji Kuroda, Keiichi Ito","doi":"10.1002/nau.70457","DOIUrl":"https://doi.org/10.1002/nau.70457","url":null,"abstract":"<p><strong>Purpose: </strong>Emerging evidence suggests a close relationship between sleep health and female lower urinary tract symptoms (LUTS). However, available studies have focused on individual sleep disorders or specific urinary symptoms, and no systematic review has comprehensively evaluated this association in women.</p><p><strong>Methods: </strong>A systematic literature search of PubMed/MEDLINE was conducted to identify studies published between January 2020 and July 2026 investigating the association between sleep-related factors and female LUTS. Eligible studies evaluated adult women with one or more sleep disorders or sleep-related characteristics and reported outcomes related to overactive bladder (OAB), urinary incontinence (UI), nocturia, voiding dysfunction, or overall LUTS. Study selection followed the PRISMA 2020 statement. A qualitative synthesis was performed because of substantial methodological heterogeneity.</p><p><strong>Results: </strong>Twenty-eight studies met the inclusion criteria. The most consistent evidence supported associations between poor sleep quality, obstructive sleep apnea (OSA), and nocturia with female LUTS. Prospective evidence demonstrated that poor sleep quality increased the risk of incident LUTS, while population-based studies identified insomnia as an independent risk factor for nocturia. Women with OAB exhibited poorer sleep quality, greater daytime sleepiness, and a higher risk of OSA, while women with UI generally exhibited poorer sleep quality. Limited evidence also suggested associations involving restless legs syndrome and healthy sleep patterns. Potential mechanisms include autonomic dysregulation, systemic inflammation, circadian rhythm disruption, hormonal alterations, and psychological distress, supporting a bidirectional relationship between sleep disorders and female LUTS.</p><p><strong>Conclusions: </strong>Current evidence demonstrates a consistent association between sleep health and female LUTS, particularly regarding sleep quality, OSA, and nocturia. Assessment of sleep health may be a reasonable clinical consideration in women with LUTS. Further prospective and interventional studies are warranted to clarify causality and determine whether treatment of sleep disorders improves urinary outcomes.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor on \"Ultrasonographic Findings of Successful Polyvinylidene Fluoride Mid-Urethral Sling Surgery and Their Clinical Relevance\".","authors":"Ömer Faruk Öz, Can Dinç, Murat Özekinci, Selen Doğan, Nasuh Utku Doğan, İnanç Mendilcioğlu","doi":"10.1002/nau.70460","DOIUrl":"https://doi.org/10.1002/nau.70460","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraprocedural Pain During Intradetrusor Onabotulinum Toxin-A Injections: A Clinical Evaluation of Pain Distribution.","authors":"Salih Zeki Sönmez, Hayder Alhusseinawi, Rachel Skews, Sonia Whittard, Hashim Hashim","doi":"10.1002/nau.70455","DOIUrl":"https://doi.org/10.1002/nau.70455","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the distribution and intensity of intraprocedural pain during intradetrusor onabotulinumtoxinA injections by assessing differences across anatomical bladder regions and diagnostic subgroups. Specifically, the study investigated whether pain perception varied based on gender, diagnosis, and injection site in patients with idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), and wet overactive bladder (OAB-wet).</p><p><strong>Methods: </strong>In this prospective observational study, 119 adult patients who underwent intradetrusor onabotulinumtoxinA injections between March 2021 and October 2023 were included. Patients were diagnosed with IDO, NDO, or OAB-wet. All procedures were performed using flexible cystoscopy under local anesthesia with Optilube gel. A standardized 20-site injection protocol was used, including two injections on each lateral wall, five in the para-trigonal region, and 11 in randomly distributed sites on the anterior and posterior bladder walls. Patients reported their pain scores for each region using a 0-10 visual analog scale (VAS). A control group of 50 patients undergoing diagnostic flexible cystoscopy provided baseline pain scores. Two-way ANOVA was used to assess differences in pain scores based on gender, diagnosis, and anatomical region.</p><p><strong>Results: </strong>A total of 119 patients (82 females, 37 males) were included, with 88 diagnosed with IDO, 28 with NDO, and 3 with OAB-wet. The mean overall VAS pain score during BoNT-A injections was 4.03 ± 1.21, compared to 1.76 ± 0.68 in 50 patients undergoing diagnostic flexible cystoscopy (p < 0.001). Among injection sites, mean scores were 3.78 for para-trigonal, 4.03 for lateral wall, and 3.11 for randomly distributed regions. Two-way ANOVA showed no significant differences in pain scores by gender or diagnosis, except for para-trigonal pain, which was higher in OAB-wet patients (p = 0.01). Excluding this subgroup, no significant difference remained between IDO and NDO (p = 0.06).</p><p><strong>Conclusions: </strong>Intravesical onabotulinumtoxinA injections are generally well tolerated under local anesthesia, though para-trigonal injections may cause greater discomfort, particularly in patients with OAB-wet. While pain perception did not differ significantly by gender or diagnosis overall, region-specific sensitivity should be considered when planning injection techniques. These findings may help inform strategies to improve procedural comfort and support individualized treatment approaches.</p><p><strong>Trial registration: </strong>This study was not registered as a clinical trial because it was a non-randomized, observational study without prospective assignment or intervention groups, consistent with ICMJE criteria.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacral Transcutaneous Electrical Nerve Stimulation Versus Oxybutynin in Children With Overactive Bladder: A Prospective Randomized Controlled Trial.","authors":"Sathyamurthy Arunaa, Ramesh Babu, Ramasundaram Madhu, Sambandan Kumaravel","doi":"10.1002/nau.70451","DOIUrl":"https://doi.org/10.1002/nau.70451","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this RCT is to compare the efficacy of sacral transcutaneous electrical nerve stimulation (TENS) with oxybutynin in children with overactive bladder (OAB), focusing on subjective & objective treatment response, adverse effects, and relapse rates.</p><p><strong>Materials and methods: </strong>In this prospective randomized controlled study, 82 children aged 5-18 years with refractory OAB were randomized to receive either sacral TENS (30 sessions; 20 min each (10 Hz) daily; for 4 weeks) or oral oxybutynin (0.2 mg/kg/day for 4 weeks). Outcomes were assessed using subjective response categories based on bladder diaries and objective measures including the Overactive Bladder Index (OABI) and Dysfunctional Voiding Symptom Score (DVSS). Adverse effects and relapse during 6-12 months of follow-up were recorded.</p><p><strong>Results: </strong>There was no significant difference between age/sex distributions between the groups. Median follow-up was 9 (6-12) months. Complete response was significantly higher with TENS than oxybutynin (68.3% vs. 31.7%; OR 4.63, 95% CI 1.8-11.7; p = 0.001). Mean improvement in OABI (4.6 ± 1.4 vs. 3.7 ± 1.0; p = 0.001) and DVSS (8.8 ± 1.5 vs. 5.7 ± 1.3; p = 0.001) favored TENS. Adverse effects (4.9% vs. 46.3%) and relapse rates (7.3% vs. 29.3%) were significantly lower with TENS.</p><p><strong>Conclusion: </strong>Sacral TENS was associated with higher response rates and fewer adverse effects than oxybutynin in this cohort supporting its role as an effective and well-tolerated therapeutic option for pediatric OAB. Further larger trials are warranted.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Storage-Pressure Urodynamic Risk in Children With Radiological Suspicion of Tethered Spinal Cord: A Single-Center Retrospective Comparative Study.","authors":"Yusuf Atakan Baltrak, Hasan Deliağa","doi":"10.1002/nau.70453","DOIUrl":"https://doi.org/10.1002/nau.70453","url":null,"abstract":"<p><strong>Objective: </strong>To compare unsafe storage-pressure urodynamic findings in children with radiological suspicion or confirmation of tethered spinal cord and in clinically referred children without radiological tethering.</p><p><strong>Materials and methods: </strong>This single-center retrospective comparative study included children aged 2-18 years who underwent urodynamic testing between October 2024 and December 2025 and had available spinal magnetic resonance imaging. Of 172 children assessed, 52 were excluded because spinal MRI was unavailable. The final cohort included 120 children: 60 with radiological tethering and 60 without tethering. The primary outcome was an unsafe storage-pressure urodynamic pattern. Post-void residual urine was excluded from the primary composite outcome and analyzed separately.</p><p><strong>Results: </strong>Age and sex were comparable between groups. Unsafe storage-pressure urodynamics were more frequent in the radiological tethered cord group than in the non-tethered comparison group (48.3% vs. 21.7%, p = 0.003). Low compliance, elevated end-filling pressure, high-pressure detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-void residual urine were also more common. MRI and urodynamic risk were not fully concordant: 51.7% of children with radiological tethering had safe storage-pressure urodynamics, whereas 21.7% without tethering had unsafe findings. Radiological tethering alone demonstrated a sensitivity of 69.0%, specificity of 60.3%, positive predictive value of 48.3%, and negative predictive value of 78.3% for unsafe storage-pressure urodynamics. In multivariable analysis, radiological tethering, increased post-void residual urine, and hydronephrosis were independently associated with unsafe storage-pressure urodynamics.</p><p><strong>Conclusions: </strong>Radiological tethering was associated with unsafe storage-pressure urodynamic findings, but MRI alone did not define functional bladder safety. Increased post-void residual urine and hydronephrosis may identify children at higher risk; however, these findings are hypothesis-generating and do not establish a validated pathway for safely withholding urodynamic testing.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}