Indications, findings, and clinical impact of invasive pediatric urodynamic studies in Iraqi children.

BACKGROUND: Pediatric urodynamic study (UDS) provides an objective functional assessment of lower urinary tract dysfunction and assists in identifying high-risk bladder abnormalities associated with renal deterioration in children. However, regional evidence regarding pediatric UDS findings and their clinical implications remains limited in the Kurdistan Region of Iraq. OBJECTIVE: To evaluate the clinical indications, urodynamic findings, and impact of pediatric UDS on patient management among children undergoing evaluation at a tertiary pediatric referral centre in Erbil, Iraq. METHODS: This retrospective observational study included pediatric patients who underwent invasive UDS between January 2019 and December 2025 at a tertiary pediatric hospital in the Kurdistan Region of Iraq. Demographic characteristics, clinical indications, urodynamic findings, and treatment modifications following UDS were retrospectively collected from archived medical records and urodynamic reports. Associations between selected urodynamic abnormalities and treatment adjustment were evaluated using Fisher's exact test. RESULTS: A total of 47 children were included, with a median age of 3.0 years (IQR, 7.0), and 78.7% were male. Vesicoureteral reflux (25.5%), posterior urethral valve (19.1%), and functional urinary incontinence (14.9%) were the most common indications for UDS. Abnormal urodynamic findings were identified in 59.6% of patients, with detrusor overactivity (21.3%), obstructive voiding (19.1%), underactive bladder (17.0%), reduced bladder compliance (19.1%), elevated detrusor leak point pressure (DLPP >40 cmH₂O; 12.8%), and abnormal sphincteric activity (10.6%) being the most frequent abnormalities. Treatment modification following UDS occurred in 48.9% of patients. Reduced bladder compliance was significantly associated with treatment adjustment (p = 0.001), whereas elevated DLPP and abnormal sphincteric activity were not significantly associated with management modification. CONCLUSION: Pediatric UDS provided clinically valuable functional information and influenced individualized management decisions in children with complex lower urinary tract disorders in the Kurdistan Region of Iraq. Reduced bladder compliance was associated with treatment modification following UDS, highlighting its clinical importance in guiding therapeutic decision-making. These findings provide one of the first regional datasets describing the indications, urodynamic findings, and management implications of pediatric UDS in Iraq.