Prospective evaluation of a pediatric urodynamics protocol before and after limiting urine cultures

Published:December 16, 2022DOI:



      While our institution has historically obtained a urine culture (UCx) from every child at the time of urodynamics (UDS), no consensus exists on UDS UCx utility, and practice varies widely. This study aims to prospectively study our symptomatic post-UDS UTI rate before and after implementing a targeted UCx protocol.

      Materials and methods

      A 2-part prospective study of patients undergoing UDS at one pediatric hospital was undertaken, divided into Phase 1 (7/2016-6/2017) with routine UCx at the time of UDS and Phase 2 (7/2019-6/2020) after implementation of a protocol limiting UCx at the time of UDS to only a targeted subset of patients. The primary outcome was symptomatic post-UDS UTI, defined as positive UCx ≥10ˆ4 CFU/mL and fever ≥38.5 °C or new urinary symptoms within seven days of UDS.


      A total of 1,154 UDS were included: 553 in 483 unique patients during Phase 1 and 601 in 533 unique patients during Phase 2. Age, sex, race, ethnicity, and bladder management did not differ significantly between phases. All 553 UDS in Phase 1 had UCx at the time of UDS, compared to 34% (204/601) in Phase 2. The rate of positive UCx decreased from 39% in Phase 1–35% in Phase 2. Three patients developed symptomatic post-UDS UTI in each study period, resulting in a stable post-UDS UTI rate of 0.5% (3/553) in Phase 1 and 0.5% (3/601) in Phase 2. These patients varied in age, sex, UDS indication, and bladder management. Four of the six (67%) patients had positive UCx at the time of UDS, one had a negative UCx, and one had no UCx under the targeted UCx protocol. Predictors of symptomatic post-UDS UTI could not be evaluated.


      In the largest prospective study to date, we found that symptomatic post-UDS UTI was <1% and that UCx at the time of UDS can safely be limited at our hospital. This reduction has important implications for cost containment and antibiotic stewardship. We will continue iterative modifications to our protocol, which may eventually include the elimination of UCx at the time of UDS in all groups.


      Summary TableUrine cultures during urodynamics and antibiotic treatment by protocol.
      Retrospective [
      • Snow-Lisy D.
      • Halline C.
      • Johnson E.K.
      Reassessing the utility of routine urine culture with urodynamics: UTI incidence and risk factors.
      Prospective: Phase 1 Prospective: Phase 2
      Time period 1/2013–1/2015 7/2016–6/2017 7/2019–6/2020
      UDS urine culture protocol No protocol, routine urine cultures UDS protocol with universal urine cultures UDS protocol with limited urine cultures
      Urine culture with UDS 993/1057 (94%) 553/553 (100%) 204/601 (34%)
      Positive culture 402/993 (40%) 218/553 (39%) 72/204 (35%)
      Received antibiotic treatment after UDS, either based on culture protocol or symptoms 23/1057 (2%) 44/553 (8%) 36/601 (6%)
      Symptomatic post-UDS UTI 15 (1.4%) 3 (0.5%) 3 (0.5%)



      UTI (urinary tract infection), UDS (urodynamics), NGB (neurogenic bladder), VUR (vesicoureteral reflux), UCx (urine culture), UA (urinalysis), CIC (clean intermittent catheterization), EMR (electronic medical record)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Casey J.T.
        • Hagerty J.A.
        • Maizels M.
        • Chaviano A.H.
        • Yerkes E.
        • Lindgren B.W.
        • et al.
        Early administration of oxybutynin improves bladder function and clinical outcomes in newborns with posterior urethral valves.
        J Urol. 2012; 188: 1516-1520
        • Bachelard M.
        • Sillen U.
        • Hansson S.
        • Hermansson G.
        • Jodal U.
        • Jacobsson B.
        Urodynamic pattern in infants with urinary tract infection.
        J Urol. 1998; 160: 522-526
        • Tsai S.W.
        • Kung F.T.
        • Chuang F.C.
        • Ou Y.C.
        • Wu C.J.
        • Huang K.H.
        Evaluation of the relationship between urodynamic examination and urinary tract infection based on urinalysis results.
        Taiwan J Obstet Gynecol. 2013; 52: 493-497
        • Hoebeke P.
        • Van Laecke E.
        • Van Camp C.
        • Raes A.
        • Van De Walle J.
        One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction.
        BJU Int. 2001; 87: 575-580
        • Routh J.C.
        • Cheng E.Y.
        • Austin J.C.
        • Baum M.A.
        • Gargollo P.C.
        • Grady R.W.
        • et al.
        Design and methodological considerations of the National Spina Bifida Patient Registry urologic and renal protocol for the newborn and young child.
        J Urol. 2016; 196: 1728-1734
        • Alsowayan O.
        • Alzahrani A.
        • Farmer J.P.
        • Capolicchio J.P.
        • Jednak R.
        • El-Sherbiny M.
        Comprehensive analysis of the clinical and urodynamic outcomes of primary tethered spinal cord before and after untethering.
        J Pediatr Urol. 2016; 12: 285.e1-285.e5
        • Skriapas K.
        • Poulakis V.
        • Dillenburg W.
        • de Vries R.
        • Witzsch U.
        • Melekos M.
        • et al.
        Tension-free vaginal tape (TVT) in morbidly obese patients with severe urodynamic stress incontinence as last option treatment.
        Eur Urol. 2006; 49: 544-550
        • Lee W.C.
        • Wu H.P.
        • Tai T.Y.
        • Yu H.J.
        • Chiang P.H.
        Investigation of urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in women with type 2 diabetes.
        J Urol. 2009; 181: 198-203
        • Sirls L.T.
        • Richter H.E.
        • Litman H.J.
        • Kenton K.
        • Lemack G.E.
        • Lukacz E.S.
        • et al.
        The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
        J Urol. 2013; 189: 204-209
        • Foon R.
        • Toozs-Hobson P.
        • Latthe P.
        Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies.
        Cochrane Database Syst Rev. 2012; 10CD008224
        • Snow-Lisy D.
        • Halline C.
        • Johnson E.K.
        Reassessing the utility of routine urine culture with urodynamics: UTI incidence and risk factors.
        J Pediatr Urol. 2017; 13: 372.e1-372.e8
        • Shekarriz B.
        • Upadhyay J.
        • Freedman A.L.
        • Fleming P.
        • Barthold J.S.
        • Gonzalez R.
        Lack of morbidity from urodynamic studies in children with asymptomatic bacteriuria.
        Urology. 1999; 54 (discussion 62): 359-361
        • Preece J.
        • Haynes A.
        • Gupta S.
        • Becknell B.
        • Ching C.
        Implications of bacteriuria in myelomeningocele patients at time of urodynamic testing.
        Top Spinal Cord Inj Rehabil. 2019 Summer; 25 (PMID:31548791; PMCID: PMC6743746): 241-247
        • Lopez Imizcoz F.
        • Burek C.M.
        • Sager C.
        • Vasquez Patiño M.
        • Gomez Y.R.
        • Szklarz M.T.
        • et al.
        Pediatric urodynamic study without a preprocedural urine culture, is it safe in clinical practice?.
        Urology. 2020 Nov; 145 (Epub 2020 Aug 8. PMID: 32781080): 224-228
        • Forster C.S.
        • Courter J.
        • Jackson E.C.
        • Mortensen J.E.
        • Haslam D.B.
        Frequency of multidrug-resistant organisms cultured from urine of children undergoing clean intermittent catheterization.
        J Pediatric Infect Dis Soc. 2017 Nov 24; 6 (PMID:29186590; PMCID: PMC5907884): 332-338
        • Malhotra N.R.
        • Green J.R.
        • Rigsby C.K.
        • Holl J.L.
        • Cheng E.Y.
        • Johnson E.K.
        Urinary tract infection after retrograde urethrogram in children: a multicenter study.
        J Pediatr Urol. 2017 Dec; 13 (Epub 2017 Jun 17. PubMed PMID: 28666918): 623.e1-623.e5
        • Johnson E.K.
        • Malhotra N.R.
        • Shannon R.
        • Jacobson D.L.
        • Green J.
        • Rigsby C.K.
        • et al.
        Urinary tract infection after voiding cystourethrogram.
        J Pediatr Urol. 2017 Aug; 13 (Epub 2017 May 25. PubMed PMID: 28579135): 384.e1-384.e7