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Urosound. In-office ultrasonography for pediatric urology
J M Donovan1, K G Ney, M Maizels
1Division of Urology, Children's Memorial Hospital, Chicago, Illinois.
Insights
Ultrasound is a safe and accurate tool for diagnosing pediatric urologic issues, including screening healthy infants for urinary tract abnormalities. Routine use can detect silent conditions early, improving patient outcomes.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
Background:
- Ultrasound is highly accurate for evaluating common pediatric urologic problems like renal obstruction and urinary infections.
- It's beneficial for screening siblings of children with known urologic disease.
- Benefits include accuracy, ease of use, no radiation, and no contrast agent reactions.
Observation:
- Ultrasound is now routine for pediatric urologic conditions and screening healthy infants.
- 1.3% of healthy infants studied had surgically significant urologic problems.
- Routine ultrasound in infants is recommended to detect silent urinary tract abnormalities cost-effectively.
Findings:
- Office-based ultrasound by clinicians is increasingly used, avoiding external referrals.
- Clinician-sonographers can directly correlate sonographic data with clinical problems.
- Experience confirms the ease and accuracy of office ultrasound for pediatric urology.
Implications:
- Urosound is indicated for evaluating voiding symptoms, infections, hematuria, and congenital anomalies like hypospadias.
- It aids in monitoring children with dysfunctional voiding and assessing hydronephrosis.
- Abnormal urosound findings facilitate more efficient planning of further diagnostic evaluations.
Abstract:
Ultrasound has proved to be very accurate in evaluating children with common urologic problems such as renal obstruction and urinary infection and in screening for uropathology among children with siblings known to have urologic disease. The benefits of ultrasound in a pediatric population include diagnostic accuracy, ease of use, absence of radiation exposure, and no risk of adverse reactions to contrast agents. As a consequence, ultrasound has become routine in the evaluation of children with urologic conditions, and its use has been expanded to screening of healthy infants for urinary tract abnormalities. One (1.3 per cent) of 73 otherwise-healthy babies studied had urologic problems severe enough to warrant surgery. Steinhart and associates recommended the routine use of ultrasound in healthy infants, because a significant number of infants harbor silent urinary tract abnormalities that can be detected by ultrasound at a low cost. Obstetricians and other primary-care physicians as well as urologists have incorporated the office use of ultrasound into the care for their patients and thus avoid the inconvenience and difficulties of outside referral. In addition, the clinician as a sonographer occupies a unique position that permits sonographic information to be related directly to the clinical problem. In this review, we have included more than three times the number of patients studied in the initial report. The ease and accuracy of office ultrasound that we described initially have been confirmed by subsequent experience. The urosound examination is indicated for the initial evaluation of patients with voiding symptoms, urine infection, or hematuria, as well as to screen patients with known congenital anomalies, such as hypospadias. Urosound can be employed in the surveillance of children with dysfunctional voiding to measure the completeness of bladder emptying and hydronephrosis. The degree of hydronephrosis in cases of ureteropelvic junction obstruction, megaureters, ectopic ureters, and ureteroceles and that remaining after surgery may be documented by urosound examination. We have found that when the urosound study is abnormal, further diagnostic evaluation is more efficiently planned. Office-based pediatric urologist-operated ultrasound supplements the information elicited from routine history, physical examination, laboratory studies, and other radiologic investigations.