Showing posts with label urinary tract. Show all posts
Showing posts with label urinary tract. Show all posts

Thursday, August 13, 2015

If You Still Think Ultrasound Is the Best Way to Diagnose Cryptorchidism, Think Again.

Todd Huffman
By: Lewis First, MD, MS; Editor-in-Chief       
        Despite the fact that the urology literature has indicated that the use of ultrasound for diagnosis of cryptorchidism delays diagnosis and management of this disorder, the practice continues.  This is why Kanaroglou et al. (doi: 10.1542/peds.2015-0222) decided to provide strong evidence against the use of ultrasound as the gold standard of diagnosis for undescended testicle by reviewing the records of boys between 0 and 18 years in Ontario using administrative data as well health records.  The authors looked at to the frequency of ultrasound use as well as time delays between diagnosis and surgical management in those patients who did and did not have ultrasound.   
        Despite the problems using ultrasound to make the diagnosis, sadly in this study the trend to use this modality increased over time resulting in a 3-month delay on average in making the definitive diagnosis and in turn treatment using surgical repair.  So who is still ordering ultrasounds when the clinical diagnosis raises suspicion?   
        Read this article and then tack down what you learn so that ultrasound is not ordered, but a urological or surgical referral is when you suspect your patient has an undescended testicle.

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Tuesday, March 25, 2014

Siblings of Children with Vesicoureteral Reflux: Who Needs a Reflux Workup?

Grade III Vesicoureteral Reflux.
Photo by radswiki via Wikimedia Commons
There are certainly benefits and risks to screening siblings of children with vesicoureteral reflux (VUR) and trying to better define just which siblings we should be screening is information that could be quite useful to have on hand.

Fortunately Hunziker et al. (doi: 10.1542/peds.2013-3498) sought such information by gaining
permission to screen children less than 6 years of age for VUR whose sibling had a documented UTI, dividing these children into those who had had a UTI and those who did not.

The authors provide quite the flow of results and help us better define just what might make us even more eager to screen a sibling for reflux. If you take a peek at this study, you’ll learn just which siblings might be most apt to benefit from the VUR workup when an index case appears in the same family.

Related Reading:

Tuesday, February 11, 2014

Just When You Thought The AAP Guidelines Had Solved How to Evaluate a UTI…

Photo by Aseev Artem via Wikimedia Commons
In 2011, the AAP via our journal published revised evidence-based guidelines for diagnosis and treatment of urinary tract infections in children (doi: 10.1542/peds.2011-1330) that received much attention and resulted in various commentaries, letters to the editor, and subsequent studies to further confirm or not confirm these guidelines.

One recommendation was that a renal and bladder ultrasound should be performed after an initial febrile UTI, and a voiding cystourethrogram should follow if the ultrasound shows an abnormality—and this has been accepted as the standard of practice—at least until Nelson et al. (doi: 10.1542/peds.2013-2109) published their early release study this week looking at almost 4,000 cases where both an ultrasound and VCUG were both performed. The sensitivity, specificity, and predictive values of ultrasound for an abnormal VCUG were determined.

Sadly, in this study, ultrasound proved to be a poor predictor of genitourinary abnormalities and a VCUG was needed even in the setting of a negative ultrasound.

Has this been the case for you? Do you agree with the findings in this study? Share your thoughts below or via an eLetter, Facebook or Twitter, or go with the flow and read an accompanying commentary by Downs et al. (doi: 10.1542/peds.2013-4158) that presents a different take on what we should do for follow-up if we identify a UTI. Read this study and commentary and learn more.

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