Objectives: To determine if two successive ultrasound examinations could rule out the presence of clinically significant contralateral anomalies in neonates with multicystic dysplastic kidney (MCDK), thereby avoiding ...Objectives: To determine if two successive ultrasound examinations could rule out the presence of clinically significant contralateral anomalies in neonates with multicystic dysplastic kidney (MCDK), thereby avoiding unnecessary voiding cystourethrography (VCUG). Study design: We followed 76 newborn infants with antenatally discovered MCDK. Two successive neonatal renal ultrasound examinations were performed, one within the first week and one at around 1 month of life. VCUG and isotopic studies were performed in all infants. Results: Urologic anomalies of the contralateral kidney were present in 19 of 76 children (25% ): vesicoureteral reflux (VUR) in 16 (21% ), ureteropelvic junction obstruction in 2 (3% ), and renal duplex kidney in 1 (1% ). Sixty-one infants (80% of total) had normal contralateral urinary tract on the 2 successive neonatal renal ultrasound scans. Among them, 4 of 61 (7% ) infants presented with low-grade VUR on VCUG that had resolved spontaneously before 2 years of age. The sensitivity, specificity, positive predictive value, and negative predictive value of two successive ultrasound scans in the neonatal period to predict contralateral urological anomalies on VCUG were 75% , 95% , 80% , and 93% , respectively. Conclusions: In infants with antenatally diagnosed MCDK, two successive normal neonatal renal ultrasound scans will rule out clinically significant contralateral anomalies, thereby rendering the need for a neonatal VCUG unnecessary.展开更多
Background and Objectives. Of children diagnosed with urinary tract infection,30% to 40% have primary vesicoureteral reflux (VUR). For the majority of these children,treatment involves long-term prophylactic antibioti...Background and Objectives. Of children diagnosed with urinary tract infection,30% to 40% have primary vesicoureteral reflux (VUR). For the majority of these children,treatment involves long-term prophylactic antibiotics (ABX) and a periodic voiding cystourethrogram (VCUG) until resolution of VUR as detected by VCUG. Radiation exposure and considerable discomfort have been associated with VCUG. To date,no clear guidelines exist regarding the timing of follow-up VCUGs. The objective of this study was to develop a clinically applicable algorithm for the optimal timing of repeat VCUGs and validate this algorithm in a retrospective cohort of children with VUR. Methods. Based on previously published data regarding the probability of resolution of VUR over time,a decision-tree model (DTM) was developed. The DTM compared the differential impact of 3 timing schedules of VCUGs (yearly,every 2 years,and every 3 years) on the average numbers of VCUGs performed,years of ABX exposure,and overall costs. Based on the DTM,an algorithmoptimizing the timing of VCUG was developed. The algorithm then was validated in a retrospective cohort of patients at an urban pediatric referral center. Data were extracted from the medical records regarding number of VCUGs,time of ABX prophylaxis,and complications associated with either. VUR in patients in the cohort was grouped into mild VUR (grades I and II and unilateral grade III for those ≤ 2 years old),and moderate/ severe VUR (other grade III and grade IV). Kaplan-Meier survival curves were created from the cohort data. From the survival curves,the median times to resolution of VUR were determined for the cohort,and these times were compared with the median times to VUR resolution of the data used for the DTM. The numbers of VCUGs performed,time of ABX exposure,and costs in the cohort were compared with those that would have occurred if the algorithm had been applied to both mild and moderate/severe VUR groups. Results. Using an algorithm that results in a recommendation of VCUGs every 2 years in mild VUR would reduce the average number of VCUGs by 42% and costs by 33% ,with an increase in ABX exposure of 16% ,compared with a schedule of yearly VCUGs. For moderate/severe VUR,a VCUG performed every 3 years would reduce the average number of VCUGs by 63% and costs by 51% ,with an increase in ABX exposure of 10% . Applying this algorithm to the retrospective cohort consisting of 76 patients (between 1 month and 10 years old) with primary VUR would have reduced overall VCUGs by 19% and costs by 6% ,with an increase in ABX exposure of 26% . The patterns of VUR resolution,age distribution,and prevalence of severity of VUR were comparable between previously published results and the retrospective cohort. Conclusions. Delaying the schedule of VCUG from yearly to every 2 years in children with mild VUR and every 3 years in children with moderate/severe VUR yields substantial reductions in the average numbers of VCUGs and costs,with amodest subsequent increase in ABX exposure.展开更多
目的报道一种改良膀胱尿道造影术,并探讨其对尿道狭窄的诊断作用。方法造影前行膀胱穿刺造瘘术,造影时自膀胱造瘘管注入对比剂、使用纱条捆紧尿道龟头部,嘱患者排尿,X线透视下拍摄患者正位片及30°~45°侧位片,之后按照经典膀...目的报道一种改良膀胱尿道造影术,并探讨其对尿道狭窄的诊断作用。方法造影前行膀胱穿刺造瘘术,造影时自膀胱造瘘管注入对比剂、使用纱条捆紧尿道龟头部,嘱患者排尿,X线透视下拍摄患者正位片及30°~45°侧位片,之后按照经典膀胱尿道造影术再次进行检查,术中进一步确定狭窄部位、长度及狭窄程度。结果共有11例患者参与研究,改良膀胱尿道造影术显示的狭窄长度与经典膀胱尿道造影术及术中确定的狭窄长度差异无统计学意义(P=0.897),但检查时间明显缩短(6 min vs.15.18 min,P<0.001)。结论改良膀胱尿道造影术可充分显示尿道狭窄部位及长度,同时有检查时间短、辐射量小等优点。展开更多
文摘Objectives: To determine if two successive ultrasound examinations could rule out the presence of clinically significant contralateral anomalies in neonates with multicystic dysplastic kidney (MCDK), thereby avoiding unnecessary voiding cystourethrography (VCUG). Study design: We followed 76 newborn infants with antenatally discovered MCDK. Two successive neonatal renal ultrasound examinations were performed, one within the first week and one at around 1 month of life. VCUG and isotopic studies were performed in all infants. Results: Urologic anomalies of the contralateral kidney were present in 19 of 76 children (25% ): vesicoureteral reflux (VUR) in 16 (21% ), ureteropelvic junction obstruction in 2 (3% ), and renal duplex kidney in 1 (1% ). Sixty-one infants (80% of total) had normal contralateral urinary tract on the 2 successive neonatal renal ultrasound scans. Among them, 4 of 61 (7% ) infants presented with low-grade VUR on VCUG that had resolved spontaneously before 2 years of age. The sensitivity, specificity, positive predictive value, and negative predictive value of two successive ultrasound scans in the neonatal period to predict contralateral urological anomalies on VCUG were 75% , 95% , 80% , and 93% , respectively. Conclusions: In infants with antenatally diagnosed MCDK, two successive normal neonatal renal ultrasound scans will rule out clinically significant contralateral anomalies, thereby rendering the need for a neonatal VCUG unnecessary.
文摘Background and Objectives. Of children diagnosed with urinary tract infection,30% to 40% have primary vesicoureteral reflux (VUR). For the majority of these children,treatment involves long-term prophylactic antibiotics (ABX) and a periodic voiding cystourethrogram (VCUG) until resolution of VUR as detected by VCUG. Radiation exposure and considerable discomfort have been associated with VCUG. To date,no clear guidelines exist regarding the timing of follow-up VCUGs. The objective of this study was to develop a clinically applicable algorithm for the optimal timing of repeat VCUGs and validate this algorithm in a retrospective cohort of children with VUR. Methods. Based on previously published data regarding the probability of resolution of VUR over time,a decision-tree model (DTM) was developed. The DTM compared the differential impact of 3 timing schedules of VCUGs (yearly,every 2 years,and every 3 years) on the average numbers of VCUGs performed,years of ABX exposure,and overall costs. Based on the DTM,an algorithmoptimizing the timing of VCUG was developed. The algorithm then was validated in a retrospective cohort of patients at an urban pediatric referral center. Data were extracted from the medical records regarding number of VCUGs,time of ABX prophylaxis,and complications associated with either. VUR in patients in the cohort was grouped into mild VUR (grades I and II and unilateral grade III for those ≤ 2 years old),and moderate/ severe VUR (other grade III and grade IV). Kaplan-Meier survival curves were created from the cohort data. From the survival curves,the median times to resolution of VUR were determined for the cohort,and these times were compared with the median times to VUR resolution of the data used for the DTM. The numbers of VCUGs performed,time of ABX exposure,and costs in the cohort were compared with those that would have occurred if the algorithm had been applied to both mild and moderate/severe VUR groups. Results. Using an algorithm that results in a recommendation of VCUGs every 2 years in mild VUR would reduce the average number of VCUGs by 42% and costs by 33% ,with an increase in ABX exposure of 16% ,compared with a schedule of yearly VCUGs. For moderate/severe VUR,a VCUG performed every 3 years would reduce the average number of VCUGs by 63% and costs by 51% ,with an increase in ABX exposure of 10% . Applying this algorithm to the retrospective cohort consisting of 76 patients (between 1 month and 10 years old) with primary VUR would have reduced overall VCUGs by 19% and costs by 6% ,with an increase in ABX exposure of 26% . The patterns of VUR resolution,age distribution,and prevalence of severity of VUR were comparable between previously published results and the retrospective cohort. Conclusions. Delaying the schedule of VCUG from yearly to every 2 years in children with mild VUR and every 3 years in children with moderate/severe VUR yields substantial reductions in the average numbers of VCUGs and costs,with amodest subsequent increase in ABX exposure.
文摘目的报道一种改良膀胱尿道造影术,并探讨其对尿道狭窄的诊断作用。方法造影前行膀胱穿刺造瘘术,造影时自膀胱造瘘管注入对比剂、使用纱条捆紧尿道龟头部,嘱患者排尿,X线透视下拍摄患者正位片及30°~45°侧位片,之后按照经典膀胱尿道造影术再次进行检查,术中进一步确定狭窄部位、长度及狭窄程度。结果共有11例患者参与研究,改良膀胱尿道造影术显示的狭窄长度与经典膀胱尿道造影术及术中确定的狭窄长度差异无统计学意义(P=0.897),但检查时间明显缩短(6 min vs.15.18 min,P<0.001)。结论改良膀胱尿道造影术可充分显示尿道狭窄部位及长度,同时有检查时间短、辐射量小等优点。
