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611 PARENT PERSPECTIVES OF THE VOIDING CYSTOURETHROGRAM: A THREE-PART PROSPECTIVE SURVEY STUDY
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
THE JOURNAL OF UROLOGY姞
e249
612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM Ariella Friedman*, Cortney Wolfe-Christensen, Amanda Toffoli, Teresa Jones, Thomas Slovis, Jack Elder, Yegappan Lakshmanan, Detroit, MI
Source of Funding: None
611 PARENT PERSPECTIVES OF THE VOIDING CYSTOURETHROGRAM: A THREE-PART PROSPECTIVE SURVEY STUDY Liza Aguiar*, Kathleen McCarten, Providence, RI; Elaine Meyer, Boston, MA; Pamela Ellsworth, Anthony Caldamone, Providence, RI INTRODUCTION AND OBJECTIVES: The VCUG is an invasive procedure that is uncomfortable and distressing for the pediatric patient. We aim to assess parent preparation prior to VCUG, identify any correlation between being informed, or having had a previous VCUG experience, and parent/patient distress level, and to investigate perceived changes in children’s behavior after the VCUG. METHODS: We conducted an IRB-approved prospective survey study. Three separate surveys were administered to parents of 45 children: the “pre-VCUG survey” was administered before the VCUG, the “post-VCUG survey” was administered within 30 minutes after the study, and the “2-week post-VCUG survey” was a telephone survey administered 2-4 weeks after the VCUG. The first two surveys were investigator-generated; the “2-week post-VCUG survey” was a modified version of a validated survey, Posthospital Behavioral Questionnaire. Survey items were both 5-point scaled and open-ended questions. Demographics, previous experience with VCUG, and having been educated about VCUG were assessed. Statistical analyses were done using STATA 7.0. RESULTS: Our populations consisted of 32 female and 13 male patients (mean age: 2.8 years) Thirty-two parents/guardians identified themselves as white and 13 as non-white. Nineteen parents/ guardians interviewed had children who had undergone a previous VCUG. Twelve parents (27%) reported having had no explanation about the VCUG by a health-care provider. Fifteen percent of non-white interviewees had received an explanation compared to 84.9% of white interviewees. Parents with previous VCUGs experience and those who had been educated anticipated more pain (3.58 vs. 1.88, p ⫽ 0.001; 0.77 vs. 3.31, p value ⫽ 0.001 respectively). However, informed parents accurately predicted the perceived pain level their child. Of the 35 parents who completed the 2-week post-VCUG survey, 11 (31%) noticed changes in their child’s behavior. Eight of these eleven parents were worried about those changes. CONCLUSIONS: We conclude that a significant number of parents are uninformed about the VCUG, which influences their expectations for the procedure. A target population to consider improving access to information is the non-white population. Although education prior to the VCUG or a previous VCUG experience can increase parent anticipated pain for their child, which may contribute to increased stress for parent and child prior to the VCUG, it is important to inform parents about the procedure so they have reasonable expectations. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Recent American Academy of Pediatrics guidelines against the use of a voiding cystourethrogram (VCUG) after most cases of initial pediatric febrile urinary tract infection (UTI) were made in order to spare patients the discomfort, expense, and radiation exposure associated with the study. It was simultaneously hoped that this would limit the study population to a group with higher theoretical risk for abnormality, increasing the pretest probability of abnormal findings. Our study aimed to assess factors that may be associated with higher likelihood of abnormal VCUG, which would allow for more judicious recommendation of the test. METHODS: A retrospective review was undertaken of all initial VCUGs performed at Children’s Hospital of Michigan between January and June, 2010. Patients with prior VCUGs or history of VUR were excluded. Factors that were assessed for increased likelihood of VUR or other Urologic abnormality included degree of bladder distension with contrast medium, department of referring physician, listed indication for VCUG (i.e. UTI, hydronephrosis), mention of recurrent or multiple UTIs on the requisition, and mention of UTI and abnormality on imaging or history that might indicate the need for VCUG (i.e. hydronephrosis, family history of VUR). ANOVA and Chi-Square tests were performed where appropriate with SPSS. RESULTS: Two hundred and sixty four patients underwent initial VCUG during this period. VUR was detected in 57 (21.5%), and Urologic abnormality including VUR was detected in 73 (27.7%). Degree of bladder distension (p⫽0.266), department of referring physician (p⫽0.755), indication for study (p⫽0.580), and history of recurrent UTI or UTI and other abnormality (p⫽0.742) were all not associated with increased likelihood of VUR. Similarly, degree of bladder distension (p⫽0.709), department of referring physician (p⫽0.472), indication for study (p⫽0.648), and history of recurrent UTI or UTI and other abnormality (p⫽0.949) were all not associated with increased likelihood of any Urologic abnormality on VCUG. CONCLUSIONS: The likelihood of an abnormal VCUG is not increased when performed after recurrent UTI, nor when performed in the setting of UTI and other abnormality on history or radiologic exam. This reasons against postponing a VCUG until after a second UTI, as the probability of a positive finding is no greater in this setting. Degree of bladder distension during the study and department of referring physician further do not contribute to the likelihood of a positive study. Source of Funding: None
613 TC99-DMSA SCAN AS FIRST INVESTIGATION TO DETECT VESICOURETERAL REFLUX AS DOCUMENTED IN VCUG: A 10-YEAR RETROSPECTIVE REVIEW OF DMSA AND VCUG IMAGING IN PATIENTS WITH FIRST FEBRILE URINARY TRACT INFECTION: A TOP-DOWN APPROACH Marlon Martinez*, David Bolong, Manila, Philippines INTRODUCTION AND OBJECTIVES: DMSA renal scintigraphy has been considered to be the gold standard for the valuation of scarring following UTIs in children. Renal scarring has been shown to better correlate with the presence of recurrent UTIs than the presence of VUR. This has led to the consideration of performing DMSA renal scanning as the initial test for the evaluation of children with VUR. This ‘top-down’ approach is based on the retrospective study by Hansson et al., indicating that 51% of 303 children with UTI had evidence of abnormal DMSA renal scans, and 26% (80 children) had VUR. Limiting VCU to those children with positive DMSA renal scans would permit 50% of children to avoid having VCUG.
THE JOURNAL OF UROLOGY姞
e249
612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM Ariella Friedman*, Cortney Wolfe-Christensen, Amanda Toffoli, Teresa Jones, Thomas Slovis, Jack Elder, Yegappan Lakshmanan, Detroit, MI
Source of Funding: None
611 PARENT PERSPECTIVES OF THE VOIDING CYSTOURETHROGRAM: A THREE-PART PROSPECTIVE SURVEY STUDY Liza Aguiar*, Kathleen McCarten, Providence, RI; Elaine Meyer, Boston, MA; Pamela Ellsworth, Anthony Caldamone, Providence, RI INTRODUCTION AND OBJECTIVES: The VCUG is an invasive procedure that is uncomfortable and distressing for the pediatric patient. We aim to assess parent preparation prior to VCUG, identify any correlation between being informed, or having had a previous VCUG experience, and parent/patient distress level, and to investigate perceived changes in children’s behavior after the VCUG. METHODS: We conducted an IRB-approved prospective survey study. Three separate surveys were administered to parents of 45 children: the “pre-VCUG survey” was administered before the VCUG, the “post-VCUG survey” was administered within 30 minutes after the study, and the “2-week post-VCUG survey” was a telephone survey administered 2-4 weeks after the VCUG. The first two surveys were investigator-generated; the “2-week post-VCUG survey” was a modified version of a validated survey, Posthospital Behavioral Questionnaire. Survey items were both 5-point scaled and open-ended questions. Demographics, previous experience with VCUG, and having been educated about VCUG were assessed. Statistical analyses were done using STATA 7.0. RESULTS: Our populations consisted of 32 female and 13 male patients (mean age: 2.8 years) Thirty-two parents/guardians identified themselves as white and 13 as non-white. Nineteen parents/ guardians interviewed had children who had undergone a previous VCUG. Twelve parents (27%) reported having had no explanation about the VCUG by a health-care provider. Fifteen percent of non-white interviewees had received an explanation compared to 84.9% of white interviewees. Parents with previous VCUGs experience and those who had been educated anticipated more pain (3.58 vs. 1.88, p ⫽ 0.001; 0.77 vs. 3.31, p value ⫽ 0.001 respectively). However, informed parents accurately predicted the perceived pain level their child. Of the 35 parents who completed the 2-week post-VCUG survey, 11 (31%) noticed changes in their child’s behavior. Eight of these eleven parents were worried about those changes. CONCLUSIONS: We conclude that a significant number of parents are uninformed about the VCUG, which influences their expectations for the procedure. A target population to consider improving access to information is the non-white population. Although education prior to the VCUG or a previous VCUG experience can increase parent anticipated pain for their child, which may contribute to increased stress for parent and child prior to the VCUG, it is important to inform parents about the procedure so they have reasonable expectations. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Recent American Academy of Pediatrics guidelines against the use of a voiding cystourethrogram (VCUG) after most cases of initial pediatric febrile urinary tract infection (UTI) were made in order to spare patients the discomfort, expense, and radiation exposure associated with the study. It was simultaneously hoped that this would limit the study population to a group with higher theoretical risk for abnormality, increasing the pretest probability of abnormal findings. Our study aimed to assess factors that may be associated with higher likelihood of abnormal VCUG, which would allow for more judicious recommendation of the test. METHODS: A retrospective review was undertaken of all initial VCUGs performed at Children’s Hospital of Michigan between January and June, 2010. Patients with prior VCUGs or history of VUR were excluded. Factors that were assessed for increased likelihood of VUR or other Urologic abnormality included degree of bladder distension with contrast medium, department of referring physician, listed indication for VCUG (i.e. UTI, hydronephrosis), mention of recurrent or multiple UTIs on the requisition, and mention of UTI and abnormality on imaging or history that might indicate the need for VCUG (i.e. hydronephrosis, family history of VUR). ANOVA and Chi-Square tests were performed where appropriate with SPSS. RESULTS: Two hundred and sixty four patients underwent initial VCUG during this period. VUR was detected in 57 (21.5%), and Urologic abnormality including VUR was detected in 73 (27.7%). Degree of bladder distension (p⫽0.266), department of referring physician (p⫽0.755), indication for study (p⫽0.580), and history of recurrent UTI or UTI and other abnormality (p⫽0.742) were all not associated with increased likelihood of VUR. Similarly, degree of bladder distension (p⫽0.709), department of referring physician (p⫽0.472), indication for study (p⫽0.648), and history of recurrent UTI or UTI and other abnormality (p⫽0.949) were all not associated with increased likelihood of any Urologic abnormality on VCUG. CONCLUSIONS: The likelihood of an abnormal VCUG is not increased when performed after recurrent UTI, nor when performed in the setting of UTI and other abnormality on history or radiologic exam. This reasons against postponing a VCUG until after a second UTI, as the probability of a positive finding is no greater in this setting. Degree of bladder distension during the study and department of referring physician further do not contribute to the likelihood of a positive study. Source of Funding: None
613 TC99-DMSA SCAN AS FIRST INVESTIGATION TO DETECT VESICOURETERAL REFLUX AS DOCUMENTED IN VCUG: A 10-YEAR RETROSPECTIVE REVIEW OF DMSA AND VCUG IMAGING IN PATIENTS WITH FIRST FEBRILE URINARY TRACT INFECTION: A TOP-DOWN APPROACH Marlon Martinez*, David Bolong, Manila, Philippines INTRODUCTION AND OBJECTIVES: DMSA renal scintigraphy has been considered to be the gold standard for the valuation of scarring following UTIs in children. Renal scarring has been shown to better correlate with the presence of recurrent UTIs than the presence of VUR. This has led to the consideration of performing DMSA renal scanning as the initial test for the evaluation of children with VUR. This ‘top-down’ approach is based on the retrospective study by Hansson et al., indicating that 51% of 303 children with UTI had evidence of abnormal DMSA renal scans, and 26% (80 children) had VUR. Limiting VCU to those children with positive DMSA renal scans would permit 50% of children to avoid having VCUG.