Purpose: Urodynamic studies (UDS) are the gold standard for evaluating pediatric lower urinary tract dysfunction (LUTD). However, previous studies have shown that the interpretation of cystometric findings may vary according to the observer’s level of experience and the criteria used for evaluation. This study aimed to investigate interobserver differences in the reporting of cystometric parameters in children with spina bifida. Methods: Patients who underwent UDS between 2020 and 2025 for neurogenic LUTD secondary to spina bifida were retrospectively reviewed. Studies that did not reach 80% agreement for compliance with good urodynamic practice standards were excluded. Detrusor overactivity (DOA) and bladder compliance were independently evaluated by 4 pediatric urologists and 3 urologists experienced in neuro-urology. Agreement was assessed using Fleiss’ kappa test. Results: A total of 100 children, including 53 females and 47 males, were included; the median age was 6.5 (range, 1–17) years. Agreement of at least 80% was reached in 86% of evaluations for DOA and 82% of evaluations for compliance. Based on the ratings of 7 observers, the Fleiss’ kappa value was 0.60 for DOA, indicating moderate agreement, and 0.46 for bladder compliance, indicating weak agreement. Conclusions This study demonstrated substantial interobserver variation in the interpretation of UDS, even among experienced centers and observers. Because UDS are essential for the diagnosis, treatment, and follow-up of patients with spina bifida, standardized criteria are needed to improve interobserver consistency in this patient group. Multicenter prospective studies involving observers with varying levels of experience are warranted to improve concordance in UDS reporting.

Purpose: Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD. Methods: A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6. Results: The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively). Conclusion This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060