Wang Zhan Tao Peter, Chan Ernest Pang, Vanin Moreno Nicolas, Filler Guido, McAleer Irene, Wehbi Elias, Chuang Kai-Wen, Khoury Antoine
Western University, London, ON, Canada.
Western University, London, ON, Canada.
Urology. 2020 Jun;140:138-142. doi: 10.1016/j.urology.2020.03.001. Epub 2020 Mar 17.
To explore the current practice patterns for the management of renal cysts internationally among pediatric urologists and nephrologists.
A survey composed of 21 questions and 4 clinical scenarios was distributed to pediatric urologists and nephrologists. Survey questions evaluated optimal imaging modality, management, and follow-up period. Interspecialty comparisons were made using chi-square analysis where appropriate.
A total of 183 respondents completed the survey (128 pediatric urologists, 37 pediatric nephrologists, and 19 other specialists). Most (57%) respondents agreed or strongly agreed with using an ultrasound based Bosniak classification to categorize renal cysts in children. The most commonly used follow-up intervals were 6-12 months for pediatric urologists and 1-2 years for pediatric nephrologists. Symptomatic mass effect (80.9%), gross hematuria (79.2%), or family history were the most common reasons for escalating surveillance. Pediatric nephrologists were more likely to increase follow-up with development of bilateral simple renal cysts (P = .008) or chronic kidney disease (P = .027) when compared to pediatric urologists. Laparoscopic marsupialization (39.4%) was the most common treatment for a simple renal cyst in a symptomatic child. Modified Bosniak III cysts had more heterogeneity in treatment based on the physician responses.
There is currently no consensus on the optimal protocol for the surveillance, imaging, or treatment of renal cysts in children. Most respondents agree that using an ultrasound-based Bosniak classification is reasonable. A call to action is therefore necessary for the development of registries and guidelines on the management of pediatric renal cysts and their associated malignancies.
探讨国际上儿科泌尿科医生和肾病科医生对肾囊肿的当前管理实践模式。
向儿科泌尿科医生和肾病科医生发放了一份包含21个问题和4个临床病例的调查问卷。调查问题评估了最佳成像方式、管理和随访期。在适当情况下，使用卡方分析进行专业间比较。
共有183名受访者完成了调查（128名儿科泌尿科医生、37名儿科肾病科医生和19名其他专科医生）。大多数（57%）受访者同意或强烈同意使用基于超声的博斯尼亚克分类法对儿童肾囊肿进行分类。儿科泌尿科医生最常用的随访间隔为6至12个月，儿科肾病科医生为1至2年。有症状的肿块效应（80.9%）、肉眼血尿（79.2%）或家族史是加强监测的最常见原因。与儿科泌尿科医生相比，儿科肾病科医生在出现双侧单纯性肾囊肿（P = 0.008）或慢性肾病（P = 0.027）时更有可能增加随访。腹腔镜袋形缝合术（39.4%）是有症状儿童单纯性肾囊肿最常见的治疗方法。根据医生的回答，改良博斯尼亚克III类囊肿在治疗上有更多的异质性。
目前对于儿童肾囊肿的监测、成像或治疗的最佳方案尚无共识。大多数受访者认为使用基于超声的博斯尼亚克分类法是合理的。因此，有必要采取行动来建立关于儿童肾囊肿及其相关恶性肿瘤管理的登记系统和指南。
