The value of cystometry for the evaluation of neurogenic bladder in infants and children: an evidence based analysis.

The question whether cystometry is an accurate and reliable method for assessment and prognostication of neurogenic bladder dysfunction in infants and children has been discussed for many years. To elucidate this question, a search of the relevant literature has been made and the identified studies subjected to evidence based analysis. It was found that the great majority of authors recommend regular cystometry on the basis of non-controlled case series which carry a rather low level of scientific evidence (level of evidence 4, grade of recommendation C). There were two notable exceptions. One, the value of the bladder cooling test (BCT) has been validated in prospective studies comparing neurologically intact children and children with neurogenic bladder (Level of Evidence 2, Grade of recommendation B). Two, studies on natural fill (ambulatory) cystometry display Level 2 Evidence (good quality prospective matched cohort studies). Natural fill cystometry thus qualifies for a Grade B recommendation as the "golden standard" for urodynamics in infants and children.