Eastern Virginia Medical School, Norfolk, Virginia, USA.
Urology of Virginia, Virginia Beach, Virginia, USA.
World J Urol. 2023 Apr;41(4):1163-1167. doi: 10.1007/s00345-023-04323-0. Epub 2023 Feb 17.
Reliability of pre-operative testing is important for adequate surgical planning. For urethral stricture disease, preoperative planning frequently includes retrograde urethrogram (RUG). The radiographic interpretation of RUGs is often done by urologists themselves. We aimed to evaluate the reliability of RUG interpretation by urologists at our institution.
We examined the RUGs of 193 patients. These were deidentified and interpreted by three urologists, two general urologists and one reconstructive urologist. These interpretations were compared in 2 ways. Each of the general urologists was compared to the "gold standard" reconstructive urologist interpretation, and the general urologists were additionally compared to each other. We used intraclass correlation coefficient (ICC) for numerical variables and Fleiss' Kappa or Cohen's Kappa statistic (κ) for categorical variables to rate inter-interpreter reliability and agreement among interpretations with regards to the quantitative variables of stricture length and caliber.
Level of agreement ranged from poor to moderate across all variables interpreted. Comparing general urologists to the gold standard yielded no better than moderate agreement, with the majority being poor to fair. Similarly, agreement amongst the general urologists did not reach above moderate, with the majority being poor to slight.
To our knowledge, this is the first analysis of inter-rater reliability of RUGs among practicing urologists. Our analysis showed clinically unacceptable reliability with regards to stricture length, location, caliber, and indicated procedures. This study suggests a need for standardized interpretation of RUGs and poses an opportunity for actionable improvement in management of strictures.
术前检查的可靠性对于充分的手术规划至关重要。对于尿道狭窄疾病，术前计划通常包括逆行尿道造影（RUG）。RUG 的放射学解读通常由泌尿科医生自己完成。我们旨在评估我们机构泌尿科医生对 RUG 解读的可靠性。
我们检查了 193 名患者的 RUG。这些 RUG 被去识别并由三位泌尿科医生（两位普通泌尿科医生和一位重建泌尿科医生）进行解读。以两种方式比较这些解读。每位普通泌尿科医生与“金标准”重建泌尿科医生的解读进行比较，并且普通泌尿科医生之间也进行了比较。我们使用了数值变量的组内相关系数（ICC）和分类变量的 Fleiss' Kappa 或 Cohen's Kappa 统计量（κ）来评估定量变量（狭窄长度和口径）的解释者之间的组内一致性和一致性。
所有变量的一致性程度从差到中度不等。将普通泌尿科医生与金标准进行比较，得出的一致性结果并不优于中度，大多数为差到中等。同样，普通泌尿科医生之间的一致性也未达到中度以上，大多数为差到轻微。
据我们所知，这是首次对实际泌尿科医生的 RUG 间评分者可靠性进行分析。我们的分析表明，在狭窄长度、位置、口径和指示的手术程序方面，其可靠性存在临床不可接受的情况。这项研究表明需要对 RUG 进行标准化解读，并为改善狭窄症的管理提供了一个可采取行动的机会。
