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Standardized protocol for voiding cystourethrogram: Are recommendations being followed?

Karmon M Janssen1, Andrew J Kirsch1, Theodore C Crisostomo-Wynne2

  • 1From Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.

Journal of Pediatric Urology
|October 31, 2020
PubMed
Summary
This summary is machine-generated.

A 2016 standardized protocol for voiding cystourethrogram (VCUG) aimed to improve reporting quality for pediatric urinary tract imaging. However, crucial data like the volume at which vesicoureteral reflux (VUR) occurs remains underreported, impacting patient care.

Keywords:
ProtocolVesicoureteral refluxVoiding cystourethrogram

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Area of Science:

  • Pediatric Urology
  • Diagnostic Imaging
  • Radiology Reporting Standards

Background:

  • The voiding cystourethrogram (VCUG) is vital for assessing urinary tract anatomy and function, particularly for detecting vesicoureteral reflux (VUR).
  • Inconsistent reporting quality led the American Academy of Pediatrics to issue a standardized VCUG protocol in 2016.

Purpose of the Study:

  • To evaluate adherence to the 2016 standardized VCUG protocol by comparing institutional reports before and after its publication.
  • To assess the impact of the protocol on the quality and completeness of VCUG reporting.

Main Methods:

  • A retrospective analysis of 3121 VCUG reports from two periods: pre-protocol (n=989) and post-protocol (n=2132).
  • Reports were assessed for adherence to recommended data points, excluding studies in patients over 18 or for trauma.
  • Key metrics included scout image reporting, cyclic studies, post-void residual (PVR) volume, infused volume, VUR grade, and reflux timing.

Main Results:

  • Post-protocol reports showed increased reporting of scout images and cyclic studies (p < 0.001).
  • However, measured PVR and infused volume decreased (p < 0.001), and reporting of reflux timing (filling vs. voiding) declined (p < 0.008).
  • The volume at which reflux occurred was increasingly reported (0.6% to 2.3%, p < 0.05), but remained vastly underreported overall.

Conclusions:

  • Despite the 2016 protocol, VCUG reporting consistency remains a challenge.
  • While VUR grade is well-reported, critical functional data like the volume at which reflux occurs is consistently underreported.
  • Underreporting of reflux volume limits individualized patient care and prediction of VUR resolution.