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Ren J, Ma T, Huang S, Chen G, Dietrich CF, Peng Y, Cui X. A narrative review on the applications of intracavitary contrast-enhanced ultrasonography in pediatric lower genitourinary anomalies. Front Pediatr 2023; 11:984643. [PMID: 37274817 PMCID: PMC10236366 DOI: 10.3389/fped.2023.984643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Purpose We mainly aimed to perform a narrative review of clinical applications of the three intracavitary contrast-enhanced ultrasonography (CEUS) including contrast-enhanced voiding urosonography (ceVUS), contrast-enhanced retrograde urethrosonography (ceRUG), and contrast-enhanced genitosonography (ceGS) in pediatric lower genitourinary anomalies. Method A literature search in the PubMed and Web of Science databases was conducted up to 1 July 2022 on all studies published in English using the search terms "contrast-enhanced voiding urosonography", "contrast-enhanced retrograde urethrosonography", and "contrast-enhanced genitosonography". Trials were limited to pediatric subjects (ages ≤18 years) with no time restrictions. The inclusion criteria were studies on ceVUS, ceRUG, and ceGS to evaluate pediatric lower genitourinary anomalies. Two independent authors summarized the included articles. Results Finally, a total of 48 original articles and 6 case reports or case series were included, of which 50 (93%) were only relevant to ceVUS, 3 (5%) articles involved ceGS, while only one (2%) article involved ceRUG, and 87% of the applications of ceVUS were focused on vesicoureteral reflux (VUR). We also searched 24 related reviews, of which 20 involved ceVUS in diagnosing VUR and 4 involved ceRUG and ceGS for other lower genitourinary anomalies. Conclusion Intracavitary CEUS including ceVUS, ceRUG, and ceGS in pediatrics has many advantages over other radiological examinations in diagnosing lower genitourinary anomalies. Although ceVUS is widely used in detecting VUR, ceRUG and ceGS have also become promising techniques for evaluating the urethral pathologies and urogenital sinus.
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Affiliation(s)
- Jiayu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Ma
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyan Huang
- Department of Ultrasound, The First People’s Hospital of Huaihua, Huaihua, China
| | - Gongquan Chen
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Yuexiang Peng
- Department of Ultrasound, The Third Hospital of Wuhan, Wuhan, China
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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ElSheemy MS. Postnatal management of children with antenatal hydronephrosis. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundPostnatal management of infants with antenatal hydronephrosis (ANH) is still one of the most controversial issues. The majority of infants with ANH are asymptomatic with only few children who develop renal insufficiency. Thus, the biggest challenge for pediatric urologists is to distinguish children who will require further investigations and possible intervention prior to the development of symptoms, complications or renal damage in a cost effective manner without exposing them to the hazards of unnecessary investigations.Main bodyIn this review article, literature on ANH were reviewed to present the current suggestions, recommendations, guidelines and their rational for postnatal management of ANH. It is agreed that a large portion of infants with ANH will improve; thus, the protocol of management is based mainly on observation and follow-up by ultrasound to detect either resolution, stabilization or worsening of hydronephrosis. The first 2 years of life are critical for this follow-up as the final picture is mostly reached during that period. Advanced imaging using voiding cystourethrography or renal scintigraphy are required for children at risk. Then, surgical intervention is selected only for a subgroup of these infants who showed worsening of hydronephrosis or renal function.ConclusionsThe protocol of management is based mainly on observation and follow-up by US to detect either resolution, stabilization or worsening of hydronephrosis. Postnatal evaluation should be performed for any neonate with a history ANH at any stage during pregnancy even if it was resolved during third trimester. Exclusion of UTI should be performed by urinalysis for all cases followed by urine culture if indicated. Serum creatinine should be performed especially in patients with bilateral ANH. US is the initial standard diagnostic imaging technique. Other imaging modalities like VCUG and nuclear renal scans may be required according to the results of the US evaluation. The most important items in decision making are the presence of bilateral or unilateral hydronephrosis, presence or absence of hydroureter, presence of lower urinary tract obstruction and degree of hydronephrosis on the initial postnatal US. Then an intervention is selected only for a subgroup of these patients who showed deterioration in renal function or degree of hydronephrosis or were complicated by UTIs. All these recommendations are based on the available literature. However, management of ANH is still a controversial issue due to lack of high evidence-based recommendations. Randomised controlled studies are still needed to provide a high level evidence for different aspects of management.
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Color Doppler Ultrasound Evaluation of Ureteral Jet Angle to Detect Vesicoureteral Reflux in Children. J Urol 2016; 195:1877-82. [DOI: 10.1016/j.juro.2016.01.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/24/2022]
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Demir S, Tokmak N, Cengiz N, Noyan A. Value of sonographic anterior-posterior renal pelvis measurements before and after voiding for predicting vesicoureteral reflux in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:490-494. [PMID: 25545034 DOI: 10.1002/jcu.22260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 10/03/2014] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Voiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR), but it is important to minimize the use of VCUG because of the urinary catheterization and radiation exposure required. Ultrasound (US) observations suggest that pelvicalyceal dilatation varies according to the degree of bladder fullness in children with urinary tract infection. The aim of this study was to assess whether anterior-posterior (AP) measurements of the renal pelvis on US before and after voiding can be used as a screening tool while predicting the presence of VUR in children. METHODS The subjects were toilet-trained children older than 4 years who required VCUG. Two groups were established based on the VCUG results: a VUR group of 40 kidney units (each unit defined as calyces and ureter) that exhibited different severities of reflux, and a control group of 68 kidney units unaffected by VUR. Prior to VCUG, US AP measurements of the renal pelvis of each kidney unit were recorded when the urinary bladder was full and again after bladder emptying. The change in AP measurement from before to after voiding was compared between the two groups. RESULTS The mean change in AP measurements from before to after voiding in the VUR group was significantly greater than that in the control group (p = 0.003). CONCLUSIONS Comparing US AP measurements of the renal pelvis before and after voiding is useful for identifying children who are suspected to have VUR and thus require immediate VCUG.
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Affiliation(s)
- Senay Demir
- Baskent University Faculty of Medicine, Radiology, Adana, Turkey
| | - Naime Tokmak
- Baskent University Faculty of Medicine, Radiology, Adana, Turkey
| | - Nurcan Cengiz
- Baskent University Faculty of Medicine, Pediatric Nephrology, Adana, Turkey
| | - Aytul Noyan
- Baskent University Faculty of Medicine, Pediatric Nephrology, Adana, Turkey
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Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CDA, Odibo AO, Somers MJG, Stein DR. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10:982-98. [PMID: 25435247 DOI: 10.1016/j.jpurol.2014.10.002] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/08/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Urinary tract (UT) dilation is sonographically identified in 1-2% of fetuses and reflects a spectrum of possible uropathies. There is significant variability in the clinical management of individuals with prenatal UT dilation that stems from a paucity of evidence-based information correlating the severity of prenatal UT dilation to postnatal urological pathologies. The lack of correlation between prenatal and postnatal US findings and final urologic diagnosis has been problematic, in large measure because of a lack of consensus and uniformity in defining and classifying UT dilation. Consequently, there is a need for a unified classification system with an accepted standard terminology for the diagnosis and management of prenatal and postnatal UT dilation. METHODS A consensus meeting was convened on March 14-15, 2014, in Linthicum, Maryland, USA to propose: 1) a unified description of UT dilation that could be applied both prenatally and postnatally; and 2) a standardized scheme for the perinatal evaluation of these patients based on sonographic criteria (i.e. the classification system). The participating societies included American College of Radiology, the American Institute of Ultrasound in Medicine, the American Society of Pediatric Nephrology, the Society for Fetal Urology, the Society for Maternal-Fetal Medicine, the Society for Pediatric Urology, the Society for Pediatric Radiology and the Society of Radiologists in Ultrasounds. RESULTS The recommendations proposed in this consensus statement are based on a detailed analysis of the current literature and expert opinion representing common clinical practice. The proposed UTD Classification System (and hence the severity of the UT dilation) is based on six categories in US findings: 1) anterior-posterior renal pelvic diameter (APRPD); 2) calyceal dilation; 3) renal parenchymal thickness; 4) renal parenchymal appearance; 5) bladder abnormalities; and 6) ureteral abnormalities. The classification system is stratified based on gestational age and whether the UT dilation is detected prenatally or postnatally. The panel also proposed a follow-up scheme based on the UTD classification. CONCLUSION The proposed grading classification system will require extensive evaluation to assess its utility in predicting clinical outcomes. Currently, the grading system is correlated with the risk of postnatal uropathies. Future research will help to further refine the classification system to one that correlates with other clinical outcomes such as the need for surgical intervention or renal function.
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Affiliation(s)
- Hiep T Nguyen
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA.
| | - Carol B Benson
- Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA; American College of Radiology (ACR), Reston, VA, USA
| | - Bryann Bromley
- American Institute of Ultrasound in Medicine (AIUM), Laurel, MD, USA
| | - Jeffrey B Campbell
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jeanne Chow
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - Beverly Coleman
- American College of Radiology (ACR), Reston, VA, USA; Society of Radiologists in Ultrasounds (SRU), Reston, VA, USA
| | - Christopher Cooper
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Jude Crino
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | - Kassa Darge
- Society for Pediatric Radiology (SPR), Reston, VA, USA
| | - C D Anthony Herndon
- Society for Fetal Urology (SFU), Linthicum, MD, USA; Society for Pediatric Urology (SPU), Beverly, MA, USA
| | - Anthony O Odibo
- Society for Maternal-Fetal Medicine (SMFM), Washington, D.C., USA
| | | | - Deborah R Stein
- American Society of Pediatric Nephrology (ASPN), The Woodlands, TX, USA
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Abstract
OBJECTIVE To evaluate non-invasive and non-ionizing methods of determining the presence of vesicoureteral reflux (VUR) and to preview upcoming ideas that have the potential of finding VUR non-invasively. MATERIALS AND METHODS We performed a PubMed search using the terms 'vesicoureteral reflux/radiography', 'vesicoureteral reflux/ultrasonography' and 'magnetic resonance imaging/urologic disease'. We also included information from a recent American Academy of Pediatrics meeting and our own research. RESULTS Voiding ultrasonography is non-radiating and has undergone significant improvements recently. Best results require instillation of contrast through invasive catheter placement, and doubts regarding sensitivity and specificity are significant. Magnetic resonance cystograms are best with catheter-instilled contrast. They are expensive, require anesthesia or sedation, and are impractical. Horizon technologies include magnetic resonance cystogram with gadolinium 'activation' within the bladder. Another promising completely non-invasive method includes warming the bladder with microwaves and measuring kidney temperatures before and after warming. Detection of a rise in kidney temperatures would indicate VUR. CONCLUSIONS Voiding cystourethrography remains the gold standard in reflux diagnosis but is invasive and submits the child to ionizing radiation. Developing technologies need improvements and further research before they may have a role in significantly decreasing voiding cystourethrography use or replacing it completely.
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Affiliation(s)
- Brent W Snow
- University of Utah, School of Medicine, Primary Children's Medical Center, Salt Lake City, UT 84113-1100, USA.
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Kljucevsek D, Kljucevsek T, Kersnik Levart T, Novljan G, Kenda RB. Catheter-free methods for vesicoureteric reflux detection: our experience and a critical appraisal of existing data. Pediatr Nephrol 2010; 25:1201-6. [PMID: 20069314 DOI: 10.1007/s00467-009-1391-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 10/29/2009] [Accepted: 11/05/2009] [Indexed: 11/26/2022]
Abstract
In recent years, the exact role of vesicoureteric reflux (VUR) in general has become controversial, though in some groups of children the knowledge of the existence or non-existence of VUR is still a very important issue. The number of techniques available for the assessment of VUR is increasing, and a new classification taking into account their real characteristics (direct/indirect, catheter-using/catheter-free, radiation-giving/radiation-free) has been proposed. The purpose of the following review is to evaluate the currently available evidence supporting the use of various catheter-free methods for VUR detection. We believe that as the clinical role of VUR has been questioned, it is even more important for the method of its detection to be user-friendly as regards catheterisation, radiation and availability. There is still no evidence supporting the assertion that any of the catheter-free methods of VUR detection might be the optimal one for any child. However, there are some groups of children who would benefit from using them. New studies using new, catheter-free methods of VUR detection or a combination of two or more of the methods described may prove useful in improving sensitivity and providing additional data on this important issue.
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Affiliation(s)
- Damjana Kljucevsek
- Paediatric Radiology Unit, University Medical Centre, Bohoriceva 20, 1000, Ljubljana, Slovenia.
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Leroy S, Vantalon S, Larakeb A, Ducou-Le-Pointe H, Bensman A. Vesicoureteral Reflux in Children with Urinary Tract Infection: Comparison of Diagnostic Accuracy of Renal US Criteria. Radiology 2010; 255:890-8. [PMID: 20501726 DOI: 10.1148/radiol.10091359] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandrine Leroy
- Centre for Statistics in Medicine, University of Oxford, Wolfson College Annex, Linton Road, OX2 6UD, Oxford, England. Sandrine
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Ochoa Sangrador C, Formigo Rodríguez E. Pruebas diagnósticas de imagen recomendadas en la infección urinaria. An Pediatr (Barc) 2007; 67:498-516. [DOI: 10.1016/s1695-4033(07)70717-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kopac M, Kenig A, Kljucevsek D, Kenda RB. Indirect voiding urosonography for detecting vesicoureteral reflux in children. Pediatr Nephrol 2005; 20:1285-7. [PMID: 15973525 DOI: 10.1007/s00467-005-1961-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 03/18/2005] [Accepted: 03/24/2005] [Indexed: 11/30/2022]
Abstract
The purpose of our prospective study was to determine the value of indirect voiding urosonography without the use of contrast-media and without filling of the bladder through a catheter (IVUS) for detection of vesicoureteral reflux (VUR) in children, compared with echo-enhanced voiding urosonography (VUS). Among 57 children (45 girls and 12 boys, aged 2.7 to 12.0 years) admitted for echo-enhanced VUS either as part of routine evaluation after urinary tract infection (UTI) or follow-up of a previously detected VUR, IVUS was also successfully performed in 47 children. The results were considered positive when there was any increase in pelvis size and/or ureter lumen width during voiding. The overall sensitivity of IVUS in the detection of VUR was 49%, specificity 75%. The most accurate results were obtained with VUR grade III, where IVUS correctly detected 6 out of 7 cases, a sensitivity of 86%. The average increase of AP pelvis diameter during voiding was highly significant only in uretero-renal units with VUR grade III. Considering the obstacles in conducting the investigation and its relatively low overall sensitivity and specificity, it seems that IVUS is not sufficiently reliable to replace echo-enhanced VUS.
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Affiliation(s)
- Matjaz Kopac
- Department of Pediatric Nephrology, University Children's Hospital, University Medical Centre Ljubljana, Stare pravde 4, 1000 Ljubljana, Slovenia
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Westwood ME, Whiting PF, Kleijnen J. How does study quality affect the results of a diagnostic meta-analysis? BMC Med Res Methodol 2005; 5:20. [PMID: 15943861 PMCID: PMC1180444 DOI: 10.1186/1471-2288-5-20] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 06/08/2005] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. METHODS This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. RESULTS Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. CONCLUSION Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited.
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Affiliation(s)
| | - Penny F Whiting
- Centre for Reviews and Dissemination, University of York, UK
| | - Jos Kleijnen
- Centre for Reviews and Dissemination, University of York, UK
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Whiting P, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol 2005; 5:19. [PMID: 15918898 PMCID: PMC1184082 DOI: 10.1186/1471-2288-5-19] [Citation(s) in RCA: 230] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 05/26/2005] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is a lack of consensus regarding the use of quality scores in diagnostic systematic reviews. The objective of this study was to use different methods of weighting items included in a quality assessment tool for diagnostic accuracy studies (QUADAS) to produce an overall quality score, and to examine the effects of incorporating these into a systematic review. METHODS We developed five schemes for weighting QUADAS to produce quality scores. We used three methods to investigate the effects of quality scores on test performance. We used a set of 28 studies that assessed the accuracy of ultrasound for the diagnosis of vesico-ureteral reflux in children. RESULTS The different methods of weighting individual items from the same quality assessment tool produced different quality scores. The different scoring schemes ranked different studies in different orders; this was especially evident for the intermediate quality studies. Comparing the results of studies stratified as "high" and "low" quality based on quality scores resulted in different conclusions regarding the effects of quality on estimates of diagnostic accuracy depending on the method used to produce the quality score. A similar effect was observed when quality scores were included in meta-regression analysis as continuous variables, although the differences were less apparent. CONCLUSION Quality scores should not be incorporated into diagnostic systematic reviews. Incorporation of the results of the quality assessment into the systematic review should involve investigation of the association of individual quality items with estimates of diagnostic accuracy, rather than using a combined quality score.
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Affiliation(s)
- Penny Whiting
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK
| | - Roger Harbord
- MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK
| | - Jos Kleijnen
- Centre for Reviews and Dissemination, University of York, York, UK
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Westwood ME, Whiting PF, Cooper J, Watt IS, Kleijnen J. Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 2005; 5:2. [PMID: 15769296 PMCID: PMC1079875 DOI: 10.1186/1471-2431-5-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Accepted: 03/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. METHODS We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. RESULTS 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. CONCLUSION There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required.
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Affiliation(s)
- Marie E Westwood
- Centre for Reviews and Dissemination, University of York, England
| | - Penny F Whiting
- MRC Health Services Research Collaboration, University of Bristol, England
| | - Julie Cooper
- Department of Radiology, York District Hospital, York, England
| | - Ian S Watt
- Department of Health Sciences, University of York, England
| | - Jos Kleijnen
- Centre for Reviews and Dissemination, University of York, England
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Darge K, Riedmiller H. Current status of vesicoureteral reflux diagnosis. World J Urol 2004; 22:88-95. [PMID: 15173954 DOI: 10.1007/s00345-004-0404-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Accepted: 04/02/2004] [Indexed: 10/26/2022] Open
Abstract
In children, diagnostic imaging for vesicoureteral reflux (VUR) encompasses both radiologic and sonographic modalities. The former comprises voiding cystourethrography (VCUG), the most widespread method for examination for reflux, and radionuclide cystography (RNC). In RNC the radiation exposure is significantly less than in VCUG with continuous fluoroscopy, but the anatomic details depicted are much inferior. With the introduction of pulsed fluoroscopy, the radiation exposure of VCUG has been markedly curtailed. VCUG is the first imaging choice for the urethra. The sonographic diagnosis of VUR with the intravesical administration of an ultrasound (US) contrast agent-voiding urosonography (VUS)-is being used increasingly in the routine diagnostic imaging work-up of reflux. Various sonographic reflux examination methods had been tried in the past. The real breakthrough came with the availability of stabilized US contrast media. Further impetus came with the introduction of harmonic US imaging. The recent release of a second generation US contrast medium promises to make a further positive impact on VUS. The diagnostic accuracy of contrast-enhanced VUS has been found to be comparable to radiologic methods. VUS is primarily performed in follow-up studies and as the primary reflux examination modality in girls.
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Affiliation(s)
- Kassa Darge
- Department of Pediatric Radiology, Institute of Radiodiagnostics, Würzburg University Hospital, Josef Schneider Strasse 2/D31, 97080 Würzburg, Germany.
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Abstract
Advances in the field of ultrasound technology and ultrasound contrast media over the past few years have also brought major improvements to pediatric sonography. Accordingly, contrast-enhanced voiding urosonography has become a valuable alternative in the diagnosis of vesicoureteral reflux. It is possible to achieve significant reduction in radiation exposure replacing the conventional radiologic methods used for reflux diagnosis with contrast-enhanced ultrasound. Through the introduction of harmonic imaging, an ultrasound scanning modality with high spatial and contrast resolution has become available. The modality was initially propagated as one to be applied in difficult-to-scan adults. However, initial experiences in pediatric applications are demonstrating the significant improvement it can bring in the ultrasound image quality, for example, in intestinal ultrasound. A further development is three-dimensional [3D] imaging using ultrasound. 3D-ultrasound not only offers an improvement in diagnosis but also in the acceptance of ultrasound in interdisciplinary work and teaching. The first applications of 3D-ultrasound in pediatrics are focusing on brain ultrasound and volume measurement of the kidneys.
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Affiliation(s)
- K Darge
- Abteilung für Pädiatrische Radiologie, Institut für Röntgendiagnostik der Bayerischen Julius-Maximilians-Universität Würzburg.
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