Merguerian Paul A, Corbett Sean T, Cravero Joseph
Department of Surgery, Sections of Urology and Pediatric Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
J Urol. 2006 Jul;176(1):299-302. doi: 10.1016/S0022-5347(06)00584-2.
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.
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.
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).
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.
儿童在膀胱尿道造影期间排尿的能力对于检测膀胱输尿管反流很重要。镇静对排尿能力的潜在影响可能会削弱我们检测膀胱输尿管反流的能力。自2001年以来，我们机构的大多数排尿膀胱尿道造影都是使用丙泊酚进行中度镇静下完成的。为了评估镇静对儿童排尿能力的影响，我们回顾性评估了一组接受镇静排尿膀胱尿道造影的患者，并将他们与一组接受非镇静排尿膀胱尿道造影的患者进行比较。
非镇静组由1996年至2001年间接受排尿膀胱尿道造影的2至8岁儿童组成。镇静组由2002年至2004年间接受排尿膀胱尿道造影的同年龄儿童组成。记录患者的特征、症状表现、膀胱容量、排空能力和诊断结果。将儿童分为接受镇静和未接受镇静两组。所有接受镇静的儿童均接受丙泊酚深度镇静。使用双侧t检验和Fisher精确检验进行统计分析。
在审查的544份病历中，287份在定义的年龄范围内。这些儿童中85%为女性。镇静组和非镇静组的性别分布均衡。尿路感染（65%）和既往膀胱输尿管反流（25%）是促使进行排尿膀胱尿道造影的最常见因素。146例患者接受了镇静，其中80例（55%）能够完成排尿。在141例未接受镇静的患者中，125例（89%）能够完成排尿（p<0.001）。
接受镇静下排尿膀胱尿道造影的儿童完成排尿的可能性较小。这一发现可能会削弱我们准确检测儿童膀胱输尿管反流的能力。在进行排尿膀胱尿道造影时，需要进行大型前瞻性研究以更好地评估膀胱排空和镇静情况。
