Improving the Patient Experience in Pediatric Cystometrography: A Prospective Observational Study

INTRODUCTION: Cystometrography, despite its invasive nature, is a crucial investigation for understanding and managing the bladder in children with neurogenic, non-neurogenic and congenital bladder conditions. Results are influenced by child behaviors and artefacts, but results can be critical in developing patient-specific management plans. This study aims to assess the child's anxiety level and distress levels prior to testing, how their behaviors affect test outcomes, and the overall experience of the child and their families. METHODS: This is a prospective observational study conducted at Monash Children's Hospital (MCH) between January 2023 and January 2025. Patients requiring cystometrography completed a Visual Analog Scale for Anxiety (VAS-A) score prior to the procedure to assess their anxiety. During the appointment, the Brief Behavioral Distress Scale (BBDS) score was completed by the attending consultant to objectively assess patients' behavior and its impact on test results. Finally, the Urodynamics Experience Questionnaire was completed by patients to provide feedback on their experience. RESULTS: Twenty patients were enrolled in the study. Eight patients were under 4 years of age (seven on clean intermittent catheters prior to the study, CICs) and 12 patients were 5-17 years old (two on CICs prior to the study). The median VAS-A score was 4.3. BBDS results showed that in four patients (20%) behavior significantly compromised the test results. Notably, the four patients with catheters inserted under general anesthetic did not exhibit behaviors that interfered with the test results. The Urodynamics Experience Questionnaire found that 17 patients (85%) experienced some level of distress, with 16 (80%) reporting discomfort. DISCUSSION: Most patients undergoing cystometrography are not adequately prepared, leading to higher anxiety prior to the procedure than afterward. Patients using CICs prior to the test demonstrated fewer disruptive behaviors during the test. In children not performing CIC, catheter placement under general anesthetic resulted in fewer disruptive behaviors. CONCLUSION: Enhancing the patient and family experience in pediatric urodynamics is essential. Future efforts should focus on multimodal preparation specific to the child's age and stage. Furthermore, managing anxiety and minimizing discomfort will improve the overall quality and outcomes of cystometrography in children.