de Kort Laetitia M O, Uiterwaal Cuno S P M, Beek Erik J A, Jan Nievelstein Rutger A, Klijn Aart J, de Jong Tom P V M
Department of Pediatric Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Urology. 2004 May;63(5):967-71; discussion 971-2. doi: 10.1016/j.urology.2003.11.047.
To evaluate the reliability of voiding cystourethrography (VCUG) to diagnose infravesical obstruction in boys.
Hard copies of the VCUG findings of 72 boys were assessed by two pediatric radiologists and two pediatric urologists. The investigators were instructed to consider six items related to infravesical obstruction: vesicoureteral reflux, bladder wall thickness, bladder diverticulum, abnormal prostatic urethra, visible urethral obstruction, and obstruction in the sphincter area. Also, a scoring system was developed using these six items. Agreement among the four investigators for evaluation of the items on VCUG and for the scoring system was assessed using the kappa statistic. All boys underwent urethrocystoscopy, and the endoscopic findings were compared with VCUG results. Odds ratios were calculated for the results of VCUG for each investigator to predict the chance of cystoscopic infravesical obstruction.
Agreement among observers for vesicoureteral reflux and bladder diverticulum was good (kappa values for paired observers of 0.82 and 0.79). Agreement for bladder wall thickness, abnormal prostatic urethra, visible urethral obstruction, obstruction in the sphincter area, and the scoring system was poor (kappa values of 0.08, 0.35, 0.33, 0.26, and 0.33, respectively). Consequently, the results of VCUG could not predict for endoscopic infravesical obstruction accurately, although substantial differences occurred among investigators. Items on which investigators reached good agreement were negatively related to the risk of having infravesical obstruction.
Because agreement among investigators in the assessment of most items on VCUG was poor and because for the items with good agreement, the predictive power was poor, the current clinical use of VCUG for diagnosing infravesical obstruction needs reevaluation.
评估排尿性膀胱尿道造影（VCUG）诊断男孩膀胱下梗阻的可靠性。
两名儿科放射科医生和两名儿科泌尿科医生对72名男孩的VCUG检查结果硬拷贝进行评估。研究人员被要求考虑与膀胱下梗阻相关的六个项目：膀胱输尿管反流、膀胱壁厚度、膀胱憩室、前列腺尿道异常、可见尿道梗阻以及括约肌区域梗阻。此外，利用这六个项目开发了一个评分系统。使用kappa统计量评估四名研究人员在VCUG项目评估和评分系统方面的一致性。所有男孩均接受了尿道膀胱镜检查，并将内镜检查结果与VCUG结果进行比较。计算每位研究人员VCUG结果的比值比，以预测膀胱镜检查发现膀胱下梗阻的可能性。
观察者在膀胱输尿管反流和膀胱憩室方面的一致性良好（配对观察者的kappa值分别为0.82和0.79）。在膀胱壁厚度、前列腺尿道异常、可见尿道梗阻、括约肌区域梗阻以及评分系统方面的一致性较差（kappa值分别为0.08、0.35、0.33、0.26和0.33）。因此，尽管研究人员之间存在显著差异，但VCUG结果无法准确预测内镜下膀胱下梗阻。研究人员达成良好一致性的项目与存在膀胱下梗阻的风险呈负相关。
由于研究人员在评估VCUG的大多数项目时一致性较差，且对于一致性良好的项目，预测能力也较差，因此目前VCUG在诊断膀胱下梗阻方面的临床应用需要重新评估。
