Mp18-19 should kub be used in the diagnosis of bladder bowel dysfunction?

You have accessJournal of UrologyCME1 Apr 2023MP18-19 SHOULD KUB BE USED IN THE DIAGNOSIS OF BLADDER BOWEL DYSFUNCTION? Alexandra Siegal, Neha Malhotra, Erin Miller, Joy Masseaux, Eva Baldisserotto, Antonio Quiros, and Fernando Ferrer Alexandra SiegalAlexandra Siegal More articles by this author , Neha MalhotraNeha Malhotra More articles by this author , Erin MillerErin Miller More articles by this author , Joy MasseauxJoy Masseaux More articles by this author , Eva BaldisserottoEva Baldisserotto More articles by this author , Antonio QuirosAntonio Quiros More articles by this author , and Fernando FerrerFernando Ferrer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Plain kidney ureter bladder radiography (KUB) is widely used for the evaluation of constipation in children with bladder and bowel dysfunction (BBD); however, there is varying evidence to support its routine diagnostic use. One drawback to KUB is radiation exposure. The dangers of radiation in children are well-documented and As Low As Reasonably Achievable states to avoid non-beneficial radiation. This risk is especially high in children who undergo repeated imaging in the follow up of constipation treatment. We sought to assess the effectiveness of KUB to diagnose children with BBD by comparing it to four diagnostic tests: the Dysfunctional Voiding Symptom Score (DVSS), Rome IV criteria, rectal diameter on ultrasound (RD), and the Bristol Stool Score. METHODS: We prospectively enrolled a cohort of patients presenting to an academic pediatric urology practice with symptoms of BBD. Severity of stool burden on KUB (mild, moderate, or severe), RD on ultrasound (≥3.4 cm), DVSS, Rome IV, and Bristol Stool Score were obtained for each patient. All imaging was interpreted by a pediatric radiologist and urologist. Primary outcomes were the association between the four diagnostic tests and KUB stool burden. Secondary measure were age, sex, BMI, treatment, and outcomes. Pearson’s rho bivariate analysis of all individual variables versus KUB was performed, as well as multivariate regressions to determine if multiple measures were predictive of KUB stool burden when combined. RESULTS: Between October 2020 and May 2022, 50 patients were enrolled. All children were under the age of 18, with a mean age of 7.5+/-2.2 years, and 38% were male. Average BMI was 19.16+/-5.34. When comparing individual variables to KUB in bivariate analyses, it was found that RD on ultrasound is predictive of significant stool burden on KUB (p=0.03). No other individual variables were predictive. In the multivariate analyses, no combination of tests was found to be predictive of KUB. Increased RD on ultrasound was not predictive of treatment response. CONCLUSIONS: We compared the effectiveness of four commonly used diagnostic tests in children with BBD to validate the use of KUB. We found insufficient evidence to support a diagnostic association between clinical symptoms (DVSS and Rome IV) and fecal load on KUB. Our results support the use of RD on ultrasound as a non-radiating alternative to KUB to determine stool burden. RD has been proposed to provide an objective measure for diagnosis and monitoring of treatment response; however, unlike prior studies, we did not find initial increased RD to be predictive of treatment response. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e231 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Siegal More articles by this author Neha Malhotra More articles by this author Erin Miller More articles by this author Joy Masseaux More articles by this author Eva Baldisserotto More articles by this author Antonio Quiros More articles by this author Fernando Ferrer More articles by this author Expand All Advertisement PDF downloadLoading ...