Urology · 2008
Posterior urethral valves: search for a diagnostic reference standard.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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de Jong Tom P V M, Radmayr Christian, Dik Pieter, Chrzan Rafal, Klijn Aart J, de Kort Laetitia, Pediatric Urology Club Meeting, Stans, Austria, January 2007
Аннотация
OBJECTIVES: To test the agreement among pediatric urologists regarding endoscopic findings concerning posterior urethral valves.
METHODS: A total of 25 experienced pediatric urologic surgeons observed 11 video fragments of cystourethroscopy in boys. For most of these boys, a strong suspicion of urethral obstruction had been present; however, some were controls. The video fragments stopped when an incision seemed about to be made using the endoscopic hook on, or behind, 17 folds/valves. The pediatric urologic surgeons were then asked whether they would have incised these folds/valves. The only additional clinical information given was that a suspicion of obstruction was present for most cases and that a few control cases had been included. They could only answer "yes" or "no."
RESULTS: Agreement of >or=80% was observed for 12 of the 17 questions. Of the 17 cases, 5 yielded agreement of 50%-75%. Only in 1 case, was 100% agreement reached. Most surgeons did not regard a flap valve at the 12-o'clock position as an obstruction. The voiding cystourethrograms of several cases with good positive agreement regarding posterior urethral valve obstruction displayed no radiologic suspicion of posterior urethral valves.
CONCLUSIONS: When judging cystoscopy results, we found fair to good agreement among pediatric urologists regarding whether a urethral obstruction is present. If a urethra appears normal on voiding cystourethrography, this does not exclude the possibility of a urethral obstruction. A true reference standard for urethral obstruction in boys does not seem to exist, and clinical data and additional diagnostic procedures are needed for diagnosis in most cases.
METHODS: A total of 25 experienced pediatric urologic surgeons observed 11 video fragments of cystourethroscopy in boys. For most of these boys, a strong suspicion of urethral obstruction had been present; however, some were controls. The video fragments stopped when an incision seemed about to be made using the endoscopic hook on, or behind, 17 folds/valves. The pediatric urologic surgeons were then asked whether they would have incised these folds/valves. The only additional clinical information given was that a suspicion of obstruction was present for most cases and that a few control cases had been included. They could only answer "yes" or "no."
RESULTS: Agreement of >or=80% was observed for 12 of the 17 questions. Of the 17 cases, 5 yielded agreement of 50%-75%. Only in 1 case, was 100% agreement reached. Most surgeons did not regard a flap valve at the 12-o'clock position as an obstruction. The voiding cystourethrograms of several cases with good positive agreement regarding posterior urethral valve obstruction displayed no radiologic suspicion of posterior urethral valves.
CONCLUSIONS: When judging cystoscopy results, we found fair to good agreement among pediatric urologists regarding whether a urethral obstruction is present. If a urethra appears normal on voiding cystourethrography, this does not exclude the possibility of a urethral obstruction. A true reference standard for urethral obstruction in boys does not seem to exist, and clinical data and additional diagnostic procedures are needed for diagnosis in most cases.