Hout Mohammad, Aoun Bilal, Atweh Lamya Ann, Merhe Ali, El-Hout Yaser
Division of Urology, American University of Beirut-Medical Center, Beirut, Lebanon.
Division of Pediatric Nephrology, American University of Beirut-Medical Center, Beirut, Lebanon.
Urol Ann. 2019 Apr-Jun;11(2):168-170. doi: 10.4103/UA.UA_124_18.
Voiding cystourethrogram (VCUG) is a very popular test performed to evaluate genitourinary tract anomalies. Nevertheless, this test can be overused and can lead to unnecessary patient discomfort, radiation exposure, and cost. We sought to study the practice patterns in ordering a VCUG in a Middle Eastern tertiary care center.
Over a period of 3 years, a retrospective analysis of all VCUG images done for pediatric patients in a single center was made. Further clinical details were extracted from the electronic health records. The specialty of an ordering physician and the reported indication for the procedure were noted. Indications for VCUG were recorded based on the AAP 2011 guidelines, NICE guidelines 2007, and ACR 2011 guidelines. Based on these criteria, patients were analyzed.
A total of 92 VCUGs were evaluated. Of all VCUGs done, pediatricians ordered the most VCUGs (50/92), followed by pediatric infectious disease (16/92), pediatric nephrology (9/92), pediatric urology (7/92), adult urology (5/92), pediatric surgery (3/92), obstetrician-gynecologist (1/92), and emergency medicine (1/92). Properly indicated VCUGs were 50% by general pediatrics, 55% by pediatric infectious disease, 45% by pediatric nephrology, 40% by adult urology, 33% by pediatric surgery, and 100% by pediatric urology.
VCUG is utilized differently by different specialties. In some centers, adult specialties may order a pediatric VCUG. General pediatricians order VCUG the most with a tendency for misuse in up to 50%. Pediatric urology is not the most ordering specialty of VCUG; however, it utilizes it most appropriately. The noted practice patterns may be improved with awareness of the indications and limitations of the study and with proper referral.
排尿性膀胱尿道造影（VCUG）是一种用于评估泌尿生殖道异常的常用检查。然而，这项检查可能被过度使用，会给患者带来不必要的不适、辐射暴露和费用。我们试图研究中东一家三级医疗中心开具VCUG检查的实践模式。
在3年的时间里，对该单一中心为儿科患者进行的所有VCUG影像进行回顾性分析。从电子健康记录中提取进一步的临床细节。记录开具检查的医生专业以及该检查报告的适应症。根据美国儿科学会（AAP）2011年指南、英国国家卫生与临床优化研究所（NICE）2007年指南和美国放射学会（ACR）2011年指南记录VCUG的适应症。基于这些标准对患者进行分析。
共评估了92例VCUG检查。在所有进行的VCUG检查中，儿科医生开具的检查最多（50/92），其次是儿科传染病科（16/92）、儿科肾脏病科（9/92）、儿科泌尿外科（7/92）、成人泌尿外科（5/92）、儿科外科（3/92）、妇产科医生（1/92）和急诊科医生（1/92）。普通儿科开具的VCUG检查适应症恰当的占50%，儿科传染病科占55%，儿科肾脏病科占45%，成人泌尿外科占40%，儿科外科占33%，儿科泌尿外科占100%。
不同专业对VCUG的使用方式不同。在一些中心，成人专科可能会开具儿科VCUG检查。普通儿科医生开具VCUG检查最多，其中高达50%存在滥用倾向。儿科泌尿外科并非开具VCUG检查最多的专业；然而，它对该检查的使用最为恰当。通过了解该检查的适应症和局限性以及进行适当转诊，可能会改善所指出的实践模式。
