Section of Pediatric Urology, Department of Pediatric Surgery, Hospital Infantil Gregorio Marañón, Madrid, Spain.
J Pediatr Urol. 2013 Dec;9(6 Pt B):1145-9. doi: 10.1016/j.jpurol.2013.04.017. Epub 2013 May 31.
Our experience in the endoscopic treatment of vesicoureteral reflux (VUR) has significantly increased during the last decade. To help develop diagnostic tests to check the success of this procedure, we evaluated the accuracy of surgeons' intraoperative observations as a predictor of treatment results.
We performed a prospective study of patients with VUR who were endoscopically treated during 1 year (106 renal units). Patients' age and gender, laterality, material used, grade of reflux, presence of ureteral duplication or associated pathology, and morphology of ureteral orifice were recorded as predictive factors related to the success rate. Surgeon and assistant indicated at the end of the endoscopic procedure whether the VUR was cured or not for each renal unit. These estimations were compared with postoperative voiding cystourethrogram results.
Overall cure rate was 75.5%. Positive predictive value (PPV) for surgeon's opinion was 0.79 and negative predictive value (NPV) was 0.40. Statistical analysis demonstrated that the association between the surgeon's opinion and the cure rate was low with a Kappa value of 0.171 (p = 0.30). PPV of assistant's opinion was 0.80 and NPV was 0.40, with a Kappa value of 0.2 (p = 0.13). Concordance of surgeon and assistant's opinion resulted in PPV of 0.79 and NPV of 0.53 (Kappa = 0.261). Kappa value did not improve when surgeon's opinion was related to other factors such as the material employed, grade of reflux, presence of ureteral duplication or associated pathology and morphology of the ureteral orifice.
In our experience, surgeon's opinion is not an accurate tool to predict the outcome of endoscopic treatment of VUR.
在过去十年中，我们在治疗膀胱输尿管反流（VUR）的内镜治疗方面积累了丰富的经验。为了帮助开发检查手术成功的诊断测试，我们评估了外科医生术中观察作为治疗结果预测指标的准确性。
我们对 1 年内（106 个肾脏单位）接受内镜治疗的 VUR 患者进行了前瞻性研究。患者的年龄、性别、侧别、使用的材料、反流程度、输尿管重复或相关病变的存在以及输尿管口的形态均作为与成功率相关的预测因素进行了记录。外科医生和助手在内镜手术结束时对每个肾脏单位的 VUR 是否治愈进行了评估。这些估计结果与术后排尿性膀胱尿道造影结果进行了比较。
总体治愈率为 75.5%。外科医生意见的阳性预测值（PPV）为 0.79，阴性预测值（NPV）为 0.40。统计分析表明，外科医生意见与治愈率之间的关联较低，Kappa 值为 0.171（p=0.30）。助手意见的 PPV 为 0.80，NPV 为 0.40，Kappa 值为 0.2（p=0.13）。外科医生和助手意见一致时，PPV 为 0.79，NPV 为 0.53（Kappa 值为 0.261）。当外科医生的意见与使用的材料、反流程度、输尿管重复或相关病变和输尿管口形态等其他因素相关时，Kappa 值并没有提高。
根据我们的经验，外科医生的意见不是预测 VUR 内镜治疗结果的准确工具。
