title: When should video and EMG be added to urodynamics in children with lower urinary tract dysfunction and is this justified by the evidence? ICI-RS 2014.
abstract: OBJECTIVE
  An ICI-RS Think Tank in 2014 discussed and evaluated the evidence for adding video and EMG to urodynamics (UDS) in children and also highlighted evidence gaps, with the aim of recommending further clinical and research protocols.
  
  
  METHODS
  A systematic analysis of the relevant literature for both X-ray (video) studies and electromyography, in combination with UDS in children with lower urinary tract dysfunction (LUTD), is summarized in this manuscript. The technical aspects are also critically reviewed.
  
  
  RESULTS
  The body of evidence for the addition of X-ray (video) to filling and voiding cystometry and the evidence for the addition of pelvic muscle surface electromyography to urodynamics is scanty and insufficient. Standards are poor and variable so uncontrolled expert opinion dominates practice.
  
  
  CONCLUSIONS
  The Think Tank has recommended that standardized ALARA ("As Low As Reasonably Achievable") principles should be adopted for video-urodynamics in children. The risk-benefit balance of X-ray exposure needs to be better evaluated and defined. Evaluation of images should be standardized and the association with pressure changes better analyzed and reported. Children's pelvic muscle surface electromyography technique should be standardized, technically improved, and its diagnostic relevance should be better evaluated.
authors.affiliation: Department of Neuro-Urology, University Hospital, Bonn, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Anding
authors.affiliation: Department of Surgery, UConn Health Center, Farmington, Connecticut.
authors.forename: Phillip
authors.initials: P
authors.lastname: Smith
authors.affiliation: Department of Pediatric Urology, University Children's Hospital UMC, Utrecht, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: de Jong
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California.
authors.forename: Christos
authors.initials: C
authors.lastname: Constantinou
authors.affiliation: Department of Urogynaecology, King's College Hospital, London, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Cardozo
authors.affiliation: Department of Urology, UMC, Utrecht, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosier
mesh_terms: D000367:Age Factors; D002648:Child; D003950:Diagnostic Techniques, Urological; D004576:Electromyography; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D001743:Urinary Bladder / Q000503:physiopathology*; D014563:Urodynamics; D014741:Video Recording
keywords: EMG; X-ray; children; lower urinary tract dysfunction; video-urodynamics