Voiding Cystography Practices and Preferences of North American Pediatric Urologists
Voiding Cystography Practices and Preferences of North American Pediatric Urologists
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DOI：
10.1016/j.juro.2009.02.138
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发表时间：
2009-07-01
影响因子：
6.6
通讯作者：
Wiener, John S.
中科院分区：
文献类型：
--
作者：
Ellison, Jonathan S.;Maxfield, Charles M.;Wiener, John S.
目的：在膀胱输尿管反流的评估和治疗中，关于排尿性膀胱造影的特定方式的选择，目前还没有达成共识。我们假设儿科泌尿科医生的选择是基于研究本身的技术因素，以及他们医院特有的制度因素。因此，我们调查儿科泌尿科医生，以确定他们目前的做法和偏好的模式排尿cystografic.Materials和方法：我们邮寄了一个匿名调查的40个问题，所有研究员的美国儿科学会泌尿科。结果：调查返回186 301研究员（62%）。在受访者中，57%在学术界，30%在私营部门，13%在混合实践中。如果可以选择透视排尿式膀胱尿道造影、放射性核素膀胱造影和排尿式超声检查，则98%和96%的男性和女性受访者首选透视排尿式膀胱尿道造影进行尿路感染的初步评估，96%的受访者首选透视排尿式膀胱尿道造影进行产前肾盂积水评估，54%的受访者首选透视排尿式膀胱尿道造影进行膀胱输尿管反流随访，59%的受访者首选透视排尿式膀胱尿道造影进行同胞筛查，63%和66%的受访者首选透视排尿式膀胱尿道造影。分别在开放式和内窥镜矫正膀胱输尿管反流后。在所有组中，不到10%的受访者首选排尿超声检查，其余受访者首选放射性核素膀胱造影。尿道排尿图像、工作人员对儿童的友好性、灵敏度和准确性是选择测试的最重要因素。在受访者中，83%的人报告说，他们的基层医院有全职的儿科放射科医生，尽管少数人在其他机构有全职的儿科放射科医生。在某些或大多数情况下，使用镇静剂的29%，很少由56%，从来没有由15%responders.Conclusions：儿科泌尿科医生更喜欢荧光镜排尿膀胱造影在所有情况下，以评估膀胱输尿管反流，但比例因适应症而异。诊断和患者问题比辐射剂量更令人担忧。儿科放射科医师的访问和获得所需研究的能力的变化也可能改变订购实践。
Purpose: Little consensus exists regarding the choice of a specific modality of voiding cystography in the evaluation and management of vesicoureteral reflux. We hypothesized that choices of pediatric urologists are based on technical factors of the studies themselves, as well as institutional factors unique to their hospital(s). Therefore, we surveyed pediatric urologists to determine their current practices and preferences of modalities of voiding cystography.Materials and Methods: We mailed an anonymous survey of 40 questions to all fellows of the American Academy of Pediatrics Section on Urology.Results: Surveys were returned from 186 of 301 fellows (62%). Of the respondents 57% were in academic, 30% in private and 13% in mixed practices. Given a choice of fluoroscopic voiding cystourethrography, radionuclide cystography and voiding ultrasonography, fluoroscopic voiding cystourethrography was preferred by 98% and 96% of respondents for initial evaluation of urinary tract infection in males and females, respectively, 96% for assessment of prenatal hydronephrosis, 54% for followup of vesicoureteral reflux, 59% for screening siblings, and 63% and 66%, respectively, after open and endoscopic correction of vesicoureteral reflux. Voiding ultrasonography was preferred by less than 10% of respondents in all groups, and radionuclide cystography was preferred by the remainder. Voiding images of the urethra, child-friendliness of staff, sensitivity and accuracy were factors most important in choosing a test. Of the respondents 83% reported full-time access to pediatric radiologists at their primary hospital, although a minority had full-time access to pediatric radiologists at additional institutions. Sedation was used in some or most cases by 29%, rarely by 56% and never by 15% of respondents.Conclusions: Pediatric urologists prefer fluoroscopic voiding cystography in all situations to evaluate vesicoureteral reflux but the proportion varies by indication. Diagnostic and patient issues are of greater concern than radiation dose. Variability in access to pediatric radiologists and ability to obtain the desired study may also alter ordering practices.