Reliability of the Grading System for Voiding Cystourethrograms in the Management of Vesicoureteral Reflux: An Interrater Comparison

Çelebi, Süleyman; Özaydın, Seyithan; Baştaş, Cemile Beşik; Kuzdan, Özgür; Erdoğan, Cankat; Yazıcı, Mehmet; Caymaz, İsmail; Sander, Serdar

doi:10.1155/2016/1684190

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…US abnormalities were documented by a consultant radiologist. VUR grading was done after MCUG procedure as per the standards [9]. DMSA scan was done by nuclear medicine specialist.…”

Section: Methodsmentioning

confidence: 99%

Renal scarring following urinary tract infections in children.

Bandari¹,

Sindgikar²,

Kumar³

et al. 2019

Sudan J Paed

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Urinary tract infection (UTI) is the most common bacterial infection seen in younger age group children. The most common risk factor for renal scarring in children with post-UTI is vesicoureteral reflux (VUR). This study looked at renal scarring following UTI in children by dimercaptosuccinic acid (DMSA) scan. It is a cross-sectional time bound study done among 40 infants and children with UTI for a period of 24 months. Their clinical presentation and laboratory data, including micturating cystourethrogram, were documented. DMSA scan, done during the follow-up, established the presence of renal scars if any. UTI was more common in males. Children with history of recurrent UTI had renal scarring. Statistical significance was noted when first and recurrent attacks of UTI were compared for clinical and diagnostic characteristics like Escherichia coli UTI (p = 0.007), increasing grades of VUR (p = 0.006) and renal scar formation (p = 0.041). The study concluded that the high grades of antenatal hydroureteronephrosis (100%), febrile UTI (34%), younger age group (67.5%) and E. coli UTI (86%) were more associated with recurrent attacks of UTI and renal scarring. DMSA, being the non-invasive test, is better proven to be an investigation of choice than other invasive modalities for follow-up of children with recurrent attacks of UTI.

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“…US abnormalities were documented by a consultant radiologist. VUR grading was done after MCUG procedure as per the standards [9]. DMSA scan was done by nuclear medicine specialist.…”

Section: Methodsmentioning

confidence: 99%

Renal scarring following urinary tract infections in children.

Bandari¹,

Sindgikar²,

Kumar³

et al. 2019

Sudan J Paed

View full text Add to dashboard Cite

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“…However, inter-rater variability is common with this assessment. Some studies have reported favorable intraclass correlation coefficient (ICC) values between 0.8 and 0.9, but lower levels of inter-rater agreement (50–60%) have also been reported ( 39 – 42 ). To improve the reliability of results, a standardized protocol should be adhered to when performing this assessment ( 37 , 43 ).…”

Section: Diagnosis and Assessmentmentioning

confidence: 99%

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

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“…At a pediatric‐centered hospital, VCUG results would be interpreted by pediatric radiologists who report detailed information about the anatomy and function of both upper and lower urinary tracts using checklists to describe technical (catheter size, contrast medium, the manner of instillation and whether it was a cyclic study), anatomical (VUR presence, grade, bladder shape and urethral image) and functional information (bladder filling and emptying) . However, there are still discrepancies in the interpretation of VUR grade 2–4 among radiologists and urologists, especially for VUR grade 3 and 4 . These differences would influence VUR treatment decisions.…”

Section: Correct Interpretation Of Vcugmentioning

confidence: 99%

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

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Reliability of the Grading System for Voiding Cystourethrograms in the Management of Vesicoureteral Reflux: An Interrater Comparison

Cited by 8 publications

References 24 publications

Renal scarring following urinary tract infections in children.

Renal scarring following urinary tract infections in children.

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

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