Radiation exposure to infants undergoing voiding cystourethrography: The importance of the digital imaging technology

Tzanis, Eleftherios; Raissaki, Maria; Konstantinos, Avgoullas; Damilakis, John; Perisinakis, Kostas

doi:10.1016/j.ejmp.2021.05.006

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…Several studies analyzing methods of dose reduction in VCUG have been published [ 17 , 23 ] and extensive work has been performed to reduce fluoroscopy dosing [ 24 , 25 ]. It is known that the examiner’s experience and modern fluoroscopy techniques have major impact on the radiation dose [ 17 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Suprapubic and Transurethral Bladder Access for Voiding Cystourethrography in Pediatric Male Patients

Schlötelburg,

Benoit,

Kasper

et al. 2024

Pediatric Reports

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Purpose: To compare suprapubic access (SPA) and transurethral catheterization (TUC) in voiding cystourethrogram (VCUG). Methods: Retrospective single-center evaluation of 311 VCUG performed in male patients under 12 years of age. Two study groups were built based on the bladder access method. TUC was performed in 213 patients, whereas 98 received SPA. The groups were compared regarding the procedural switch rate, the complication rate, radiation parameters, the amount of contrast media applied and the examination quality. Complications were graded in minor (contrast leakage, premature termination of the examination) and major (fever, urinary tract infection, bladder perforation). Fluoroscopy time and radiation parameters were compared. Examination quality was assessed based on the satisfactory acquisition of fluoroscopic images using a four-point Likert scale. Results: In 9% of the SPA examinations a method switch to TUC was necessary. The minor complication rate was 1.9% for TUC and 35.7% for SPA (p < 0.001). The major complication rate was 0.9% for TUC and 2% for SPA (p > 0.05). Mean fluoroscopy time and radiation dose were significantly lower in TUC (TUC, 26 ± 19 s, 0.6 ± 1.2 µGy·m2; SPA, 38 ± 33 s, 1.7 ± 2.9 µGy·m2; p = 0.01/0.001). There was no significant difference regarding the amount of contrast media applied (TUC, 62 ± 40 mL; SPA, 66 ± 41 mL; p > 0.05) and the examination quality with full diagnostic quality achieved in 88% of TUC and 89% of SPA examinations (p > 0.05). Conclusions: As TUC provides significantly lower radiation exposure and less periprocedural complications, it should be the primary bladder access route for VCUG in pediatric male patients.

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Section: Discussionmentioning

confidence: 99%

Suprapubic and Transurethral Bladder Access for Voiding Cystourethrography in Pediatric Male Patients

Schlötelburg,

Benoit,

Kasper

et al. 2024

Pediatric Reports

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“…This radiologic test is an invasive procedure requiring urethral catheterization, often painful and traumatic for the child, causing UTIs in 1 to 3% of cases [ 13 , 14 ]. Although a diagnostic study can be achieved with a relatively low radiation dose by using careful technique and modern equipment, in practice, the range of doses is extremely wide [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Management of Children with Vesicoureteral Reflux

Chirico,

Tripodi,

Lacquaniti

et al. 2023

JCM

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Contrasting data refer to therapies for vesicoureteral reflux (VUR), such as surgical treatments and continuous antibiotic prophylaxis (CAP). This study evaluated the effectiveness of these approaches in children with VUR, analyzing the recurrence of febrile urinary tract infections (UTIs) and the resolution of VUR after the treatment. A total of 350 pediatric patients underwent contrast-enhanced voiding urosonography (ceVUS) to diagnose a VUR, whereas renal scintigraphy evaluated potential scars. After 12 months from the treatment, the VUR, the relapse of febrile UTIs, and reflux-related nephropathy were analyzed. Twenty-seven children had recurrent febrile UTIs after surgical therapy, with a greater rate of relapses observed in III and V VUR grades. Thirteen patients who underwent surgery had scars, independently of VUR grades and gender, with evidence of chronic renal failure at the end of the follow-up period. A total of 140 subjects were treated with CAP, and 30% of them continued to suffer from febrile UTIs. Ninety-five patients with VUR underwent ceVUS after 12 months, with persistent reflux in fifty-two patients. All of them had severe VUR, correlating with the age at diagnosis and gender. CAP therapy prevented scarring better than surgery, especially in children with III and V grades of VUR. A late onset of VUR or VUR involving neonatal patients is rarely a reversible process. This study identified predictors of success or failure of surgical or CAP therapies, evaluating the relapse of UTIs or persistent reflux after the treatment and giving prognostic information in children with VUR.

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Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review

Hewitt,

Roebuck,

Montini

2023

Pediatr Radiol

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Background A first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time. Objective To determine the extent to which pediatricians and surgeons differ in their investigation and management of a first febrile UTI, and to evaluate the justifications for any divergence of approach. Materials and methods A literature search was conducted for papers addressing investigation and/or management following a first febrile UTI in children published between 2011 and 2021. Searches were conducted on Medline, Embase, and the Cochrane Controlled Trials Register. To be eligible for inclusion, a paper was required to provide recommendations on one or more of the following: ultrasound (US) and voiding cystourethrogram (VCUG), the need for continuous antibiotic prophylaxis and surgery when vesicoureteral reflux (VUR) was detected. The authorship required at least one pediatrician or surgeon. Authorship was categorized as medical, surgical, or combined. Results Pediatricians advocated less imaging and intervention and were more inclined to adopt a “watchful-waiting” approach, confident that any significant abnormality, grades IV–V VUR in particular, should be detected following a second febrile UTI. In contrast, surgeons were more likely to recommend imaging to detect VUR (p<0.00001), and antibiotic prophylaxis (p<0.001) and/or surgical correction (p=0.004) if it was detected, concerned that any delay in diagnosis and treatment could place the child at risk of kidney damage. Papers with combined authorship displayed intermediate results. Conclusion There are two distinct directions in the literature regarding the investigation of an uncomplicated first febrile UTI in a child. In general, when presented with a first febrile UTI in a child, physicians recommend fewer investigations and less treatment, in contrast to surgeons who advocate extensive investigation and aggressive intervention in the event that imaging detects an abnormality. This has the potential to confuse the carers of affected children.

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Radiation exposure to infants undergoing voiding cystourethrography: The importance of the digital imaging technology

Cited by 5 publications

References 33 publications

Suprapubic and Transurethral Bladder Access for Voiding Cystourethrography in Pediatric Male Patients

Suprapubic and Transurethral Bladder Access for Voiding Cystourethrography in Pediatric Male Patients

Therapeutic Management of Children with Vesicoureteral Reflux

Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review

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