Documented Bladder Volume-Guided Timing and First-Attempt Pediatric Uroflowmetry Process Adequacy: A Retrospective Workflow Cohort Study

Background/Objectives: Pediatric uroflowmetry is volume dependent, and low-volume voids can yield recordings that require repetition or cannot be interpreted confidently. To evaluate whether documented bladder volume-guided timing was associated with first-attempt pediatric uroflowmetry process adequacy in children undergoing evaluation for suspected non-neurogenic lower urinary tract dysfunction. Methods: This single-center retrospective workflow cohort included 110 toilet-trained children aged 5–12 years who underwent uroflowmetry for suspected non-neurogenic lower urinary tract dysfunction. The exposure was classified from contemporaneous pre-test documentation as bladder volume-guided timing (n = 55) or standard urge-based timing (n = 55). Expected bladder capacity (EBC) was calculated as (age + 1) × 30 mL. The primary process outcome was first-attempt voided volume ≥ 50% EBC. Repetition after an inadequate first attempt was treated as a deterministic workflow consequence rather than an independent endpoint. Analyses were observational and effect estimates were interpreted as associations. Results: Adequate first-attempt voided volume was documented in 50/55 children (90.9%) with bladder volume-guided timing and 39/55 (70.9%) with standard urge-based timing (unadjusted risk ratio 1.28, 95% confidence interval [CI] 1.06–1.55; Newcombe risk difference 20.0 percentage points, 95% CI 5.3–34.0). After adjustment for age, baseline urgency score, and time since last void, the association remained (adjusted risk ratio 1.27, 95% CI 1.06–1.53; p = 0.011), and the model converged without numerical warnings. Using the age-specific lowest acceptable voided volume, adequacy occurred in 53/55 children (96.4%) versus 46/55 (83.6%) (adjusted risk ratio 1.15, 95% CI 1.01–1.31; p = 0.040). Repetition after an inadequate first attempt occurred in 9.1% versus 29.1% and was treated as a direct consequence of primary-threshold failure; it was not tested independently. Workflow-time measures were exploratory. Conclusions: Documented bladder volume-guided timing was associated with greater first-attempt process adequacy. Adjustment for age, baseline urgency score, and time since last void did not materially change the estimate. The association was attenuated but remained directionally consistent when the age-specific lowest acceptable voided volume was used. Because the timing rule deliberately targeted the same volume construct as the primary outcome, this finding does not establish improved diagnostic accuracy, clinical decision making, or patient outcomes. Retrospective exposure classification and routine documentation further preclude causal interpretation. Documented bladder volume-guided timing was associated with higher first-attempt achievement of a prespecified voided-volume threshold than standard urge-based timing. Because the pathway targeted the same volume construct used to define the primary outcome and was non-randomized, these findings are interpreted as hypothesis-generating workflow data rather than evidence of improved diagnostic accuracy or downstream clinical benefit.