A systematic review of interventions for reducing pain and distress in children undergoing voiding cystourethrography

Area of Science:

• Pediatric Urology
• Pain Management
• Evidence-Based Medicine

Background:

• Voiding cystourethrography (VCUG) is a standard diagnostic tool for pediatric urological conditions like vesicoureteric reflux.
• The procedure can induce significant distress, pain, and anxiety in infants and children, impacting patient experience and cooperation.
• Effective strategies are needed to mitigate procedural discomfort during VCUG in pediatric populations.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) evaluating interventions aimed at reducing distress, pain, or anxiety during VCUG.
• To identify evidence-based methods for improving the tolerability of VCUG in pediatric patients.

Main Methods:

• A systematic review of randomized controlled trials was conducted.
• Studies focused on interventions to reduce distress, pain, or anxiety during voiding cystourethrography.
• Eight trials involving 591 participants met the inclusion criteria for analysis.

Main Results:

• Conscious sedation using midazolam demonstrated significant effectiveness in alleviating distress for children older than 1 year undergoing VCUG.
• Psychological preparation techniques and the use of warmed contrast medium showed potential benefits in reducing patient distress.
• Nitrous oxide (50%) emerged as a possible alternative to midazolam, though further research is recommended.

Conclusions:

• Midazolam-based conscious sedation is a well-supported method for managing VCUG-associated distress in children over one year of age.
• Non-pharmacological approaches like psychological preparation and environmental modifications (warmed contrast) warrant consideration.
• Further high-quality research is necessary to confirm the efficacy of nitrous oxide as an alternative sedation strategy for pediatric VCUG.