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EDITORIAL COMMENT

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These authors present a method of judging abnor-mal pediatric uroflowmetry objectively by computer.This is a valuable contribution to science because inthe literature this has only been done for bladderoutlet obstruction in adults. For pediatric lower uri-nary tract symptoms only expert opinion exists. Anexpert system is described as that which producesan objective judgment of flow curves. A drawback ofthe study is that after repeat reading the concept ofthe system remained difficult for me to understand.The fact that staccato and interrupted flows werejoined into 1 group makes it impossible to discrimi-

der. By definition the staccato flow pattern haspeaks and troughs without attaining the zero linewhile interrupted flow passes zero. Finally, thefact that only average to reasonable interobserveragreement was found between pediatric urologists(� 0.21 to 0.61), indicates that further studies ofpediatric uroflowmetry are needed with better de-fined criteria.

Tom P. V. M. de Jong

Department of Pediatric UrologyUniversity Children’s Hospital

University Medical Center Utrecht

nate dysfunctional voiding from underactive blad- Utrecht, The Netherlands

The interobserver agreement rate indicates thatwe are not speaking the same language regardingpediatric lower urinary tract symptoms, and thecomparison of the uroflowmetry data from differentinstitutes may be futile without objective standard-ization. We expect the present methodology will en-able analysis of pediatric uroflowmetry on a multi-institutional basis.

The discrimination between staccato and inter-rupted pattern may not be straightforward. It iseasy to define typical staccato and interrupted pat-terns but the actual clinical curves do not followsuch simplification. How should one classify a curvewith multiple peaks, which reaches the zero line

How should one differentiate terminal dribbing frominterrupted voiding? We cannot objectively definethese 2 patterns. Also, it is not scientific to assumethat dysfunctional voiding and underactive bladderfunction can be differentiated by uroflowmetry curvealone.

The concept of the present system is simple, al-though the actual calculation procedure may be per-ceived as difficult. We are generating software foruniversal use of this patterning system, which willprovide a patterning result from UFM parameters(ie gender, voided volume, maximal flow rate andamplitude of maximal fluctuation). The softwarewill be available from the corresponding author