- Email: [email protected]
MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
Pediatrics: Urinary Tract Infection and Vesicoureteral Reflux Moderated Poster Sunday, May 8, 2016
3:30 PM-5:30 PM
MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES Linda Lee*, Armando Lorenzo, Rakan Odeh, Paul Bowlin, Jeffrey Traubici, Martin Koyle, Toronto, Canada INTRODUCTION AND OBJECTIVES: While VCUG is a widely accepted test, it is invasive and associated with radiation exposure. Most cases of VUR are low-grade and unlikely to be associated with acquired renal scarring. In an effort to select patients at greatest risk, the American Academy of Pediatrics (AAP) published revised guidelines on urinary tract infections in children ages 2 to 24 months in 2011. In this project, we examine contemporary practice patterns and indications for VCUG, in the context of newer evidence-based guidelines. We hypothesize that the rate of VCUGs has declined over time, which may be geared towards detection of more clinically significant VUR. METHODS: All VCUGs performed at our institution from 2008 to present were identified. Follow-up VCUGs were excluded. Further data collection was performed for patients whom had a VCUG in the first six months of 2009 and 2014, in order to obtain representative data before and after publication of the 2011 AAP guidelines. Medical records for these patients were retrospectively reviewed for baseline patient characteristics, indication for VCUG, type of ordering physician, prior history of febrile UTIs, renal and bladder ultrasound and renal scan findings. RESULTS: From January 2008 to August 2014, a total of 8214 VCUGs were performed at our institution. The annual number of VCUGs has declined steadily over time. We then compared the 6-month periods from January to June (inclusive) in 2009 and 2014, which identified 634 and 292 VCUGs, respectively. There were no statistically significant differences in mean age or gender between both groups. Although there was a decline in VCUGs in 2014, the rate of VCUGs performed for UTIs remained the same (65% in 2009 and 64% in 2014, p¼0.88). In both groups, pediatric urologists comprised the minority of ordering physicians (14% in 2009 and 16% in 2014, p¼0.48). While there is no statistically significant difference in detection rate of VUR from 2009 to 2014 (31% vs. 37%, p¼0.07), there has been a three-fold increase in diagnosis of high grade (IV-V) VUR in 2014, compared to 2009 (10.2% vs 3.2%, p¼0.0001). CONCLUSIONS: There has been an overall trend towards fewer VCUGS being performed at our institution, even prior to the 2011 AAP guidelines. While the majority of VUR cases detected remain low-grade, there has been a higher detection rate of high-grade (IV-V) VUR in 2014, compared to 2009. This may be a reflection of changing practice patterns of ordering physicians. Source of Funding: None
e735
MP55-02 BLADDER WALL THICKNESS IN SONOGRAPHY FOR YOUNG CHILDREN WITH VUR Ho Song Yu*, Yang Hyun Cho, Je Guk Ryu, Deokhyeon Nam, Seong Woong Na, Bo Sung Shin, Ho Seok Chung, Eu Chang Hwang, Sun-ouck Kim, Seung Il Jung, Taek Won Kang, Dongdeuk Kwon, Kwangsung Park, Gwangju, Korea, Republic of INTRODUCTION AND OBJECTIVES: It has been suggested that infants with dilating vesicoureteral reflux (VUR) often have lower urinary tract (LUT) dysfunction. However, the relation between anatomical abnormality of bladder and VUR was not immediately clear. The aim of the present study was to evaluate association between bladder wall thickness and VUR in young children. METHODS: We performed retrospective analysis of Renal bladder ultrasonography (RBUS) findings in children 2-24 months with VUR over an 5 years period. Patients who had poor quality of sonography and checked sonography on collapsed state of bladder were excluded at this study. We measured the thickness of the low echogenic layer of the ventral and dorsal bladder walls at full bladder. Patients with bladder wall thickening were compared by VUR grade. RESULTS: The thickness of the low echogenic layer of the ventral and dorsal walls was 2.7 mm (0.9-4.1 mm) and 2.9 mm (1.4~5.5 mm). The dorsal wall was slightly thicker than the ventral wall. Of 128 patients, 48(37.5%) patients were excluded by poor quality of sonography or collapsed bladder state, 80(62.5%) patients had VUR, of which 22(27.5%) patients had high grade VUR (HGVUR). In multivariate analysis, dorsal wall thickness greater than 2.5 mm (odds ratio, 32.6; 95% confidence interval, 3.1-136.6; P ¼ .004) was the only independent risk factor for HGVUR. On the other hand, ventral wall thickness was not associated with HGVUR. CONCLUSIONS: Dorsal wall thickness is associated with increased risk of HGVUR. But ventral wall thickness has no correlation with HGVUR.
Source of Funding: none
MP55-03 INTER-RATER RELIABILITY OF DISTAL URETERAL DIAMETER RATIO COMPARED TO GRADE FOR VESICOURETERAL REFLUX Amanda Swanton*, Angela M. Arlen, Siobhan E. Alexander, Kathleen Kieran, Douglas W. Storm, Christopher S. Cooper, Iowa City, IA INTRODUCTION AND OBJECTIVES: Management of vesicoureteral reflux (VUR) in children remains controversial, and is dependent upon individual risk for further infections, potential for renal scarring, and likelihood of spontaneous VUR resolution. VUR grade constitutes an important prognostic factor; however studies have demonstrated poor inter-rater reliability. Recent work suggests that distal ureteral diameter ratio (UDR) may be a more predictive alternative for assessing clinical outcomes than grade of reflux. We aimed to
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
Pediatrics: Urinary Tract Infection and Vesicoureteral Reflux Moderated Poster Sunday, May 8, 2016
3:30 PM-5:30 PM
MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES Linda Lee*, Armando Lorenzo, Rakan Odeh, Paul Bowlin, Jeffrey Traubici, Martin Koyle, Toronto, Canada INTRODUCTION AND OBJECTIVES: While VCUG is a widely accepted test, it is invasive and associated with radiation exposure. Most cases of VUR are low-grade and unlikely to be associated with acquired renal scarring. In an effort to select patients at greatest risk, the American Academy of Pediatrics (AAP) published revised guidelines on urinary tract infections in children ages 2 to 24 months in 2011. In this project, we examine contemporary practice patterns and indications for VCUG, in the context of newer evidence-based guidelines. We hypothesize that the rate of VCUGs has declined over time, which may be geared towards detection of more clinically significant VUR. METHODS: All VCUGs performed at our institution from 2008 to present were identified. Follow-up VCUGs were excluded. Further data collection was performed for patients whom had a VCUG in the first six months of 2009 and 2014, in order to obtain representative data before and after publication of the 2011 AAP guidelines. Medical records for these patients were retrospectively reviewed for baseline patient characteristics, indication for VCUG, type of ordering physician, prior history of febrile UTIs, renal and bladder ultrasound and renal scan findings. RESULTS: From January 2008 to August 2014, a total of 8214 VCUGs were performed at our institution. The annual number of VCUGs has declined steadily over time. We then compared the 6-month periods from January to June (inclusive) in 2009 and 2014, which identified 634 and 292 VCUGs, respectively. There were no statistically significant differences in mean age or gender between both groups. Although there was a decline in VCUGs in 2014, the rate of VCUGs performed for UTIs remained the same (65% in 2009 and 64% in 2014, p¼0.88). In both groups, pediatric urologists comprised the minority of ordering physicians (14% in 2009 and 16% in 2014, p¼0.48). While there is no statistically significant difference in detection rate of VUR from 2009 to 2014 (31% vs. 37%, p¼0.07), there has been a three-fold increase in diagnosis of high grade (IV-V) VUR in 2014, compared to 2009 (10.2% vs 3.2%, p¼0.0001). CONCLUSIONS: There has been an overall trend towards fewer VCUGS being performed at our institution, even prior to the 2011 AAP guidelines. While the majority of VUR cases detected remain low-grade, there has been a higher detection rate of high-grade (IV-V) VUR in 2014, compared to 2009. This may be a reflection of changing practice patterns of ordering physicians. Source of Funding: None
e735
MP55-02 BLADDER WALL THICKNESS IN SONOGRAPHY FOR YOUNG CHILDREN WITH VUR Ho Song Yu*, Yang Hyun Cho, Je Guk Ryu, Deokhyeon Nam, Seong Woong Na, Bo Sung Shin, Ho Seok Chung, Eu Chang Hwang, Sun-ouck Kim, Seung Il Jung, Taek Won Kang, Dongdeuk Kwon, Kwangsung Park, Gwangju, Korea, Republic of INTRODUCTION AND OBJECTIVES: It has been suggested that infants with dilating vesicoureteral reflux (VUR) often have lower urinary tract (LUT) dysfunction. However, the relation between anatomical abnormality of bladder and VUR was not immediately clear. The aim of the present study was to evaluate association between bladder wall thickness and VUR in young children. METHODS: We performed retrospective analysis of Renal bladder ultrasonography (RBUS) findings in children 2-24 months with VUR over an 5 years period. Patients who had poor quality of sonography and checked sonography on collapsed state of bladder were excluded at this study. We measured the thickness of the low echogenic layer of the ventral and dorsal bladder walls at full bladder. Patients with bladder wall thickening were compared by VUR grade. RESULTS: The thickness of the low echogenic layer of the ventral and dorsal walls was 2.7 mm (0.9-4.1 mm) and 2.9 mm (1.4~5.5 mm). The dorsal wall was slightly thicker than the ventral wall. Of 128 patients, 48(37.5%) patients were excluded by poor quality of sonography or collapsed bladder state, 80(62.5%) patients had VUR, of which 22(27.5%) patients had high grade VUR (HGVUR). In multivariate analysis, dorsal wall thickness greater than 2.5 mm (odds ratio, 32.6; 95% confidence interval, 3.1-136.6; P ¼ .004) was the only independent risk factor for HGVUR. On the other hand, ventral wall thickness was not associated with HGVUR. CONCLUSIONS: Dorsal wall thickness is associated with increased risk of HGVUR. But ventral wall thickness has no correlation with HGVUR.
Source of Funding: none
MP55-03 INTER-RATER RELIABILITY OF DISTAL URETERAL DIAMETER RATIO COMPARED TO GRADE FOR VESICOURETERAL REFLUX Amanda Swanton*, Angela M. Arlen, Siobhan E. Alexander, Kathleen Kieran, Douglas W. Storm, Christopher S. Cooper, Iowa City, IA INTRODUCTION AND OBJECTIVES: Management of vesicoureteral reflux (VUR) in children remains controversial, and is dependent upon individual risk for further infections, potential for renal scarring, and likelihood of spontaneous VUR resolution. VUR grade constitutes an important prognostic factor; however studies have demonstrated poor inter-rater reliability. Recent work suggests that distal ureteral diameter ratio (UDR) may be a more predictive alternative for assessing clinical outcomes than grade of reflux. We aimed to