The accuracy of cystography under general anesthesia in children with vesicoureteral reflux
Purpose To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR). Materials and Methods A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold‐standard), and who are candidates for endoscopic VUR repai...
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| Veröffentlicht in: | Neurourology and urodynamics 2023-01, Vol.42 (1), p.349-354 |
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| creator | Frumer, Michael Sivan, Bezalel May, Tal Morag, Roy Khunovich, Dmitry Ben‐Meir, David |
| description | Purpose
To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR).
Materials and Methods
A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold‐standard), and who are candidates for endoscopic VUR repair surgery. All children subsequently underwent a cystography under general anesthesia before injection using standardized method, which was compared to the gold‐standard cystography. χ2 and Mann–Whitney U tests were used to compare proportions and medians between groups.
Results
Between 2017 and 2021, 126 renal units in 13 boys and 50 girls were included. Median age was 3.4 years (interquartile range [IQR] 1.5−6.5). Median time from cystography without to cystography with general anesthesia was 3.8 months (IQR 2.7−6). Of the 126 renal units, 96 had VUR on cystography without general anesthesia. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative and positive predictive values of cystography under general anesthesia were 47% (45/96), 87% (26/30), 34% (26/77) and 92% (45/49), respectively. Accuracy was 56.3%; Cohen's Kappa coefficient was 0.22, indicating poor agreement. In subgroup analysis, the sensitivity of cystography under general anesthesia was significantly lower in primary VUR (20% vs. 55% in secondary VUR, p = 0.01) and active VUR (14% vs. 52% in passive VUR, p = 0.008).
Conclusion
Cystography under general anesthesia was poorly correlated to cystography performed while the child was awake or lightly sedated. Clinical decision relying on this cystography is questionable. |
| doi_str_mv | 10.1002/nau.25105 |
| format | Article |
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To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR).
Materials and Methods
A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold‐standard), and who are candidates for endoscopic VUR repair surgery. All children subsequently underwent a cystography under general anesthesia before injection using standardized method, which was compared to the gold‐standard cystography. χ2 and Mann–Whitney U tests were used to compare proportions and medians between groups.
Results
Between 2017 and 2021, 126 renal units in 13 boys and 50 girls were included. Median age was 3.4 years (interquartile range [IQR] 1.5−6.5). Median time from cystography without to cystography with general anesthesia was 3.8 months (IQR 2.7−6). Of the 126 renal units, 96 had VUR on cystography without general anesthesia. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative and positive predictive values of cystography under general anesthesia were 47% (45/96), 87% (26/30), 34% (26/77) and 92% (45/49), respectively. Accuracy was 56.3%; Cohen's Kappa coefficient was 0.22, indicating poor agreement. In subgroup analysis, the sensitivity of cystography under general anesthesia was significantly lower in primary VUR (20% vs. 55% in secondary VUR, p = 0.01) and active VUR (14% vs. 52% in passive VUR, p = 0.008).
Conclusion
Cystography under general anesthesia was poorly correlated to cystography performed while the child was awake or lightly sedated. Clinical decision relying on this cystography is questionable.</description><identifier>ISSN: 0733-2467</identifier><identifier>EISSN: 1520-6777</identifier><identifier>DOI: 10.1002/nau.25105</identifier><identifier>PMID: 36423246</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Accuracy ; Anesthesia ; Anesthesia, General ; Child ; Child, Preschool ; Children ; cystography ; Cystography - methods ; diagnostic imaging ; Female ; General anesthesia ; Humans ; Infant ; Kidney ; Male ; Prospective Studies ; Retrospective Studies ; urinary bladder diseases ; Urinary Tract Infections - complications ; Vesico-Ureteral Reflux - diagnostic imaging ; Vesico-Ureteral Reflux - surgery ; vesico‐ureteral reflux</subject><ispartof>Neurourology and urodynamics, 2023-01, Vol.42 (1), p.349-354</ispartof><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2435-1822b03f1d3d86363a1eb6932859a7dba1185cc8e6fe781f1769385dcbf813713</cites><orcidid>0000-0002-4879-4861</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fnau.25105$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fnau.25105$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36423246$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frumer, Michael</creatorcontrib><creatorcontrib>Sivan, Bezalel</creatorcontrib><creatorcontrib>May, Tal</creatorcontrib><creatorcontrib>Morag, Roy</creatorcontrib><creatorcontrib>Khunovich, Dmitry</creatorcontrib><creatorcontrib>Ben‐Meir, David</creatorcontrib><title>The accuracy of cystography under general anesthesia in children with vesicoureteral reflux</title><title>Neurourology and urodynamics</title><addtitle>Neurourol Urodyn</addtitle><description>Purpose
To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR).
Materials and Methods
A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold‐standard), and who are candidates for endoscopic VUR repair surgery. All children subsequently underwent a cystography under general anesthesia before injection using standardized method, which was compared to the gold‐standard cystography. χ2 and Mann–Whitney U tests were used to compare proportions and medians between groups.
Results
Between 2017 and 2021, 126 renal units in 13 boys and 50 girls were included. Median age was 3.4 years (interquartile range [IQR] 1.5−6.5). Median time from cystography without to cystography with general anesthesia was 3.8 months (IQR 2.7−6). Of the 126 renal units, 96 had VUR on cystography without general anesthesia. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative and positive predictive values of cystography under general anesthesia were 47% (45/96), 87% (26/30), 34% (26/77) and 92% (45/49), respectively. Accuracy was 56.3%; Cohen's Kappa coefficient was 0.22, indicating poor agreement. In subgroup analysis, the sensitivity of cystography under general anesthesia was significantly lower in primary VUR (20% vs. 55% in secondary VUR, p = 0.01) and active VUR (14% vs. 52% in passive VUR, p = 0.008).
Conclusion
Cystography under general anesthesia was poorly correlated to cystography performed while the child was awake or lightly sedated. Clinical decision relying on this cystography is questionable.</description><subject>Accuracy</subject><subject>Anesthesia</subject><subject>Anesthesia, General</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>cystography</subject><subject>Cystography - methods</subject><subject>diagnostic imaging</subject><subject>Female</subject><subject>General anesthesia</subject><subject>Humans</subject><subject>Infant</subject><subject>Kidney</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>urinary bladder diseases</subject><subject>Urinary Tract Infections - complications</subject><subject>Vesico-Ureteral Reflux - diagnostic imaging</subject><subject>Vesico-Ureteral Reflux - surgery</subject><subject>vesico‐ureteral reflux</subject><issn>0733-2467</issn><issn>1520-6777</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kLtOwzAUhi0EoqUw8ALIEgsMob7El4xVxU2qYGknBstxnCZVmhS7oeTtMU1hQGI60jmfPv3nB-ASozuMEBnXur0jDCN2BIaYERRxIcQxGCJBaURiLgbgzPsVQkjSODkFA8pjQsNhCN7mhYXamNZp08Emh6bz22bp9KboYFtn1sGlra3TFdS19dvC-lLDsoamKKvM2Rruym0BP8LaNK2z2z3qbF61n-fgJNeVtxeHOQKLh_v59CmavT4-TyezyJCYsghLQlJEc5zRTHLKqcY25QklkiVaZKnGWDJjpOW5FRLnWISjZJlJc4mpwHQEbnrvxjXvbQip1qU3tqpC4qb1igiaiDj4eECv_6CrkLoO6QLFEoTiWCSBuu0p4xrvwzNq48q1dp3CSH03rkLjat94YK8OxjZd2-yX_Kk4AOMe2JWV7f43qZfJold-AQgbigI</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Frumer, Michael</creator><creator>Sivan, Bezalel</creator><creator>May, Tal</creator><creator>Morag, Roy</creator><creator>Khunovich, Dmitry</creator><creator>Ben‐Meir, David</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4879-4861</orcidid></search><sort><creationdate>202301</creationdate><title>The accuracy of cystography under general anesthesia in children with vesicoureteral reflux</title><author>Frumer, Michael ; Sivan, Bezalel ; May, Tal ; Morag, Roy ; Khunovich, Dmitry ; Ben‐Meir, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2435-1822b03f1d3d86363a1eb6932859a7dba1185cc8e6fe781f1769385dcbf813713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Accuracy</topic><topic>Anesthesia</topic><topic>Anesthesia, General</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>cystography</topic><topic>Cystography - methods</topic><topic>diagnostic imaging</topic><topic>Female</topic><topic>General anesthesia</topic><topic>Humans</topic><topic>Infant</topic><topic>Kidney</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>urinary bladder diseases</topic><topic>Urinary Tract Infections - complications</topic><topic>Vesico-Ureteral Reflux - diagnostic imaging</topic><topic>Vesico-Ureteral Reflux - surgery</topic><topic>vesico‐ureteral reflux</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Frumer, Michael</creatorcontrib><creatorcontrib>Sivan, Bezalel</creatorcontrib><creatorcontrib>May, Tal</creatorcontrib><creatorcontrib>Morag, Roy</creatorcontrib><creatorcontrib>Khunovich, Dmitry</creatorcontrib><creatorcontrib>Ben‐Meir, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neurourology and urodynamics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Frumer, Michael</au><au>Sivan, Bezalel</au><au>May, Tal</au><au>Morag, Roy</au><au>Khunovich, Dmitry</au><au>Ben‐Meir, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The accuracy of cystography under general anesthesia in children with vesicoureteral reflux</atitle><jtitle>Neurourology and urodynamics</jtitle><addtitle>Neurourol Urodyn</addtitle><date>2023-01</date><risdate>2023</risdate><volume>42</volume><issue>1</issue><spage>349</spage><epage>354</epage><pages>349-354</pages><issn>0733-2467</issn><eissn>1520-6777</eissn><abstract>Purpose
To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR).
Materials and Methods
A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold‐standard), and who are candidates for endoscopic VUR repair surgery. All children subsequently underwent a cystography under general anesthesia before injection using standardized method, which was compared to the gold‐standard cystography. χ2 and Mann–Whitney U tests were used to compare proportions and medians between groups.
Results
Between 2017 and 2021, 126 renal units in 13 boys and 50 girls were included. Median age was 3.4 years (interquartile range [IQR] 1.5−6.5). Median time from cystography without to cystography with general anesthesia was 3.8 months (IQR 2.7−6). Of the 126 renal units, 96 had VUR on cystography without general anesthesia. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative and positive predictive values of cystography under general anesthesia were 47% (45/96), 87% (26/30), 34% (26/77) and 92% (45/49), respectively. Accuracy was 56.3%; Cohen's Kappa coefficient was 0.22, indicating poor agreement. In subgroup analysis, the sensitivity of cystography under general anesthesia was significantly lower in primary VUR (20% vs. 55% in secondary VUR, p = 0.01) and active VUR (14% vs. 52% in passive VUR, p = 0.008).
Conclusion
Cystography under general anesthesia was poorly correlated to cystography performed while the child was awake or lightly sedated. Clinical decision relying on this cystography is questionable.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36423246</pmid><doi>10.1002/nau.25105</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4879-4861</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Accuracy Anesthesia Anesthesia, General Child Child, Preschool Children cystography Cystography - methods diagnostic imaging Female General anesthesia Humans Infant Kidney Male Prospective Studies Retrospective Studies urinary bladder diseases Urinary Tract Infections - complications Vesico-Ureteral Reflux - diagnostic imaging Vesico-Ureteral Reflux - surgery vesico‐ureteral reflux |
| title | The accuracy of cystography under general anesthesia in children with vesicoureteral reflux |
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