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The diagnostic value, parental and patient acceptability of micturating cysto-urethrography in children
M Robinson1, J Savage, M Stewart
1Royal Belfast Hospital for Sick Children, Belfast.
Insights
Micturating cysto-urethrography (MCUG) causes significant distress in children and parents, with many experiencing urinary issues post-procedure. Alternative imaging and sedation should be considered for this invasive test.
Area of Science:
- Pediatric Radiology
- Urology
- Child Psychology
Background:
- Micturating cysto-urethrography (MCUG) is a common diagnostic imaging procedure in pediatric urology.
- Indications for MCUG often include recurrent urinary tract infections (UTIs) and suspected congenital abnormalities.
- The procedure's impact on children's psychological and physical well-being requires thorough evaluation.
Purpose of the Study:
- To assess the medical indications for performing MCUG in children.
- To evaluate the outcomes of MCUG, including psychological and physical consequences for both children and their parents.
- To identify potential improvements in the procedure's management and alternatives.
Main Methods:
- A prospective study involving 165 children undergoing MCUG.
- Collection of medical data and recording of child distress by radiographers during the procedure.
- Postal questionnaires sent to parents one week post-test to gather information on perceived distress and behavioral changes.
Main Results:
- Urinary tract infections were the primary indication for 73% of initial MCUGs.
- Abnormal findings were more frequent in infants (52%) compared to older children (13%).
- Significant distress was reported by 27% of children and 27% of parents; 25% of children experienced post-procedure voiding difficulties.
Conclusions:
- MCUG is associated with a high incidence of distress for children and parents.
- Specialized guidelines for performing this invasive procedure are recommended.
- Clear explanations, consideration of sedation, and evaluation of alternative imaging methods like indirect isotope cystography are advisable.
Objectives:
To evaluate the medical indications and outcome including psychological and physical consequences of micturating cysto urethrography.
Methods:
A prospective study of 165 consecutive children undergoing MCUG during a 3 month period. Medical data, including outcome was recorded. The distress of the child was recorded by the radiographer at the time of the examinations. Postal questionnaires were sent to parents one week after the test to obtain information on their own and their child's perception of the test, and any physical and/or behavioural changes.
Results:
Age distribution for first and subsequent MCUG. [table: see text] 73% of first MCUG's were requested because of urinary tract infection. 52% of first MCUG's in infants were abnormal compared with 13% in older children aged 1 to 4 years. 29 children aged 4 and over underwent a second or subsequent MCUG (53% abnormal). These children would be suitable for indirect cystography. One quarter of children experienced difficulty in passing urine following the test, haematuria was experienced by four. Radiographers recorded severe distress in 27% of children and 27% of parents also recorded distress.
Conclusions:
A high incidence of distress was detected for both parent and child. Units should establish special guidelines for the use of this invasive procedure. A clear explanation of the investigation to parents and children should be standard practice. Routine employment of sedation for patients may be advisable. Alternative methods of imaging should be considered and evaluated, and indirect isotope cystography employed where appropriate.