Jonathan Ellison, Presenter: Nothing to Disclose

John S. Wiener MD, Abstract Co-Author: Nothing to Disclose

Charles M. Maxfield MD, Abstract Co-Author: Nothing to Disclose

Much debate surrounds the use of voiding urography modalities for work-up and management of vesicoureteral reflux (VUR). Often, the preferences of the pediatric urologist are not made known to the radiologist performing the study.

An anonymous survey of 37 questions was mailed to all Fellows of the American Academy of Pediatrics Section of Urology.

Surveys were received from 126 of 301 (42%) Fellows. Demographic data of respondents revealed 56% in academic, 32% in private and 11% in mixed practices. Fluoroscopic voiding cystouretherogram (fVCUG) was desired by the majority of pediatric urologists in all situations (work-up of initial UTI in both sexes, follow-up of VUR, sibling screening, work-up of pre-natal hydronephrosis, and follow-up of open and endoscopic correction of VUR); Voiding urosonography (VUS) was desired by < 10% in all groups; radionuclide cystography (RNC) was desired by the remainder. Of factors considered “very important” for determining modality used, 63% noted accuracy of grading, 33% noted availability of modalities, 63% noted child-friendliness of staff, 79% noted imaging of urethra during voiding, 25% noted patient age, 32% noted radiation dose, and 60% noted sensitivity of the test. Of factors considered “not important”, 0% noted accuracy of grading, 33% noted availability of modalities, 13% noted child-friendliness of staff, 2% noted imaging of urethra, 35% noted patient age, 15% noted radiation dose, and 32% noted sensitivity of the test. The remainder noted these factors to be “somewhat important”. Radiation exposure was a main factor for 2%, a consideration for 64%, and not a factor for 33%. Sedation was used in some/most cases by 30%, rarely by 56% and never by 14%. Most imaging views were desired except for lateral images; only 55% of respondents received all views desired.

fVCUG remains the test of choice in all situations among pediatric urologists. Radiation concerns are secondary to diagnostic and patient care concerns in choice of modality.

Open dialogue between pediatric urologists and radiologists regarding imaging options for evaluation of VUR will help to improve patient care.

Ellison, J, Wiener, J, Maxfield, C, Current Preferences and Practices in Voiding Urography: A Survey of Pediatric Urologists.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006154.html