PD40-01 ACCURACY OF CYSTOGRAPHY IN CHILDREN UNDER GENERAL ANESTHESIA WITH SUSPECTED VESICOURETERAL REFLUX

Abstract

You have accessJournal of UrologyCME1 May 2022PD40-01 ACCURACY OF CYSTOGRAPHY IN CHILDREN UNDER GENERAL ANESTHESIA WITH SUSPECTED VESICOURETERAL REFLUX Michael Frumer, Bezalel Sivan, Tal May, Roy Morag, Dmitry Khunovich, and David Ben Meir Michael FrumerMichael Frumer More articles by this author , Bezalel SivanBezalel Sivan More articles by this author , Tal MayTal May More articles by this author , Roy MoragRoy Morag More articles by this author , Dmitry KhunovichDmitry Khunovich More articles by this author , and David Ben MeirDavid Ben Meir More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002601.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystography under general anesthesia has proven a safe procedure in several studies. Some radiologists prefer to insert the catheter and perform examinations under anesthesia for their and the child's convenience. This study compares cystography under light sedation to cystography under general anesthesia. METHODS: A prospective study of children who had vesicoureteral reflux (VUR) on cystography without general anesthesia, and underwent endoscopic injection of bulking agent into the ureter. Pre-operative clinical and radiological data were recorded. All children subsequently underwent a cystography under general anesthesia prior to injection using standardized method, which included bladder filling to iliac crest level, and external abdominal pressure to look for active reflux. This cystography was compared to cystography performed without general anesthesia. Chi-square and Mann–Whitney U tests were used to compare proportions and medians between groups. RESULTS: Between October 2017 and January 2021, 92 renal units in 8 boys and 38 girls were evaluated. Median age was 3 years (IQR 1.5, 5). Median time from cystography without to cystography with general anesthesia was 3.7 months (IQR 2.6, 5.9). Of the 92 renal units, 73 had VUR on cystography without general anesthesia, considered as gold standard. VUR grades by the gold standard are presented in Table 1. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative predictive value and positive predictive value of cystography with general anesthesia were 41% (30/73), 79% (15/19), 26% (15/58), and 88% (30/34) (Table 2). Cohen’s Kappa coefficient between the two cystography was 0.11, indicating poor agreement. In subgroup analyses, the sensitivity of cystography with general anesthesia for filling phase VUR was 45% (29/64) vs. 11% (1/9) for voiding phase VUR (P=0.05). CONCLUSIONS: Cystography with general anesthesia was poorly correlated to cystography performed while the child was lightly sedated. Clinical decision relying on this cystography is questionable. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e683 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Frumer More articles by this author Bezalel Sivan More articles by this author Tal May More articles by this author Roy Morag More articles by this author Dmitry Khunovich More articles by this author David Ben Meir More articles by this author Expand All Advertisement PDF DownloadLoading ...