Video urodynamic study: the need for application and attempts to implement possible analogues

Bladder dysfunction in children, particularly due to spinal cord malformations, requires ongoing and precise monitoring. Video urodynamics (VUDS) remains the "gold standard" in this case, although its invasiveness and use of X-ray contrast drive the search for gentler alternatives. This task is especially critical in pediatrics. This review analyzes how closely existing alternative methods can approach the diagnostic value of classical VUDS. Based on an analysis of a series of clinical studies, it can be stated that certain non-invasive techniques—such as ultrasound assessment of bladder wall thickness, elastography, or a combination of uroflowmetry with EMG—indeed show diagnostic potential. Some studies have found correlations between their parameters and VUDS data, allowing them to be considered as tools for primary screening to identify risk groups. However, a key conclusion consistently seen in the literature is that none of these methods can become a full-fledged replacement for invasive urodynamics. They do not provide a direct and accurate assessment of intravesical pressure, do not always detect detrusor-sphincter dyssynergia, and often fail to capture vesicoureteral reflux in real time. The sensitivity and specificity of these methods vary, and their results can be contradictory, preventing them from fundamentally changing treatment strategies. Thus, this review allows the reader to form a comprehensive understanding of the current place of non-invasive technologies in pediatric urodynamics. The main takeaway is this: despite all technological attempts, video urodynamics retains its status as an indispensable method for making an accurate diagnosis in complex cases of lower urinary tract dysfunction. New techniques play an important but auxiliary role, helping to reduce the number of unjustified invasive procedures, but they do not eliminate the need for VUDS where a complete and objective assessment is required. This knowledge is critically important for clinicians determining a management strategy for a child.