Paul A Merguerian1, Sean T Corbett, Joseph Cravero. 1. Department of Surgery, Sections of Urology and Pediatric Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. paul.merguerian@hitchcock.org
Abstract
PURPOSE: The ability of a child to void during cystourethrography is important in detecting vesicoureteral reflux. The potential effect of sedation on the capacity to void may impair our ability to detect vesicoureteral reflux. Since 2001, most voiding cystourethrograms at our institution have been performed with moderate sedation using propofol. To assess the impact of sedation on the ability of children to void, we retrospectively evaluated a group of patients who underwent sedated voiding cystourethrograms and compared them to a group undergoing nonsedated voiding cystourethrograms. MATERIALS AND METHODS: The nonsedated group consisted of children 2 to 8 years old who underwent voiding cystourethrography between 1996 and 2001. The sedated group consisted of children the same age who underwent voiding cystourethrography between 2002 and 2004. Patient characteristics, presenting symptoms, bladder capacity, emptying ability and diagnoses were recorded. Children were categorized as receiving sedation vs not receiving sedation. All sedated children received propofol deep sedation. Statistical analyses were performed using the 2-sided t test and Fisher's exact test. RESULTS: Of 544 charts reviewed 287 were within the age range defined. Of these children 85% were female. Sex was evenly matched between the sedated and nonsedated groups. Urinary tract infections (65%) and previous vesicoureteral reflux (25%) were the most common factors prompting voiding cystourethrography. Sedation was administered in 146 patients, of whom 80 (55%) were able to void to completion. Of the 141 patients who did not receive sedation 125 (89%) were able to void to completion (p <0.001). CONCLUSIONS: Children who underwent voiding cystourethrography with sedation were less likely to void to completion. This finding may impair our ability to detect vesicoureteral reflux in children accurately. Large prospective studies are needed for better assessment of bladder emptying and sedation when performing voiding cystourethrography.
PURPOSE: The ability of a child to void during cystourethrography is important in detecting vesicoureteral reflux. The potential effect of sedation on the capacity to void may impair our ability to detect vesicoureteral reflux. Since 2001, most voiding cystourethrograms at our institution have been performed with moderate sedation using propofol. To assess the impact of sedation on the ability of children to void, we retrospectively evaluated a group of patients who underwent sedated voiding cystourethrograms and compared them to a group undergoing nonsedated voiding cystourethrograms. MATERIALS AND METHODS: The nonsedated group consisted of children 2 to 8 years old who underwent voiding cystourethrography between 1996 and 2001. The sedated group consisted of children the same age who underwent voiding cystourethrography between 2002 and 2004. Patient characteristics, presenting symptoms, bladder capacity, emptying ability and diagnoses were recorded. Children were categorized as receiving sedation vs not receiving sedation. All sedated children received propofol deep sedation. Statistical analyses were performed using the 2-sided t test and Fisher's exact test. RESULTS: Of 544 charts reviewed 287 were within the age range defined. Of these children 85% were female. Sex was evenly matched between the sedated and nonsedated groups. Urinary tract infections (65%) and previous vesicoureteral reflux (25%) were the most common factors prompting voiding cystourethrography. Sedation was administered in 146 patients, of whom 80 (55%) were able to void to completion. Of the 141 patients who did not receive sedation 125 (89%) were able to void to completion (p <0.001). CONCLUSIONS:Children who underwent voiding cystourethrography with sedation were less likely to void to completion. This finding may impair our ability to detect vesicoureteral reflux in children accurately. Large prospective studies are needed for better assessment of bladder emptying and sedation when performing voiding cystourethrography.