Dataset Information

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys.

ABSTRACT:

Background

Infravesical obstruction leads to kidney and bladder dysfunction in a significant proportion of boys. The aim of this review is to determine the value of diagnostic tests for ascertainment of infravesical obstruction in boys.

Methodology

We searched PubMed and EMBASE databases until January 1, 2013, to identify papers that described original diagnostic accuracy research for infravesical obstruction in boys. We extracted information on (1) patient characteristics and clinical presentation of PUV and (2) diagnostic pathway, (3) diagnostic accuracy measures and (4) assessed risk of bias.

Principal findings

We retrieved 15 studies describing various diagnostic pathways in 1,189 boys suspected for infravesical obstruction. The included studies reflect a broad clinical spectrum of patients, but all failed to present a standardised approach to confirm the presence and severity of obstruction. The risk of bias of included studies is rather high due to work-up bias and missing data.

Conclusions

As a consequence of low quality of methods of the available studies we put little confidence in the reported estimates for the diagnostic accuracy of US, VCUG and new additional tests for ruling in or ruling out infravesical obstruction. To date, firm evidence to support common diagnostic pathways is lacking. Hence, we are unable to draw conclusions on diagnostic accuracy of tests for infravesical obstruction. In order to be able to standardise the diagnostic pathway for infravesical obstruction, adequate design and transparent reporting is mandatory.

SUBMITTER: Hennus PM

PROVIDER: S-EPMC3930523 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys.

Hennus Pauline M L PM de Kort Laetitia M O LM Bosch J L H JL de Jong Tom P V M TP van der Heijden Geert J M G GJ

PloS one 20140220 2

<h4>Background</h4>Infravesical obstruction leads to kidney and bladder dysfunction in a significant proportion of boys. The aim of this review is to determine the value of diagnostic tests for ascertainment of infravesical obstruction in boys.<h4>Methodology</h4>We searched PubMed and EMBASE databases until January 1, 2013, to identify papers that described original diagnostic accuracy research for infravesical obstruction in boys. We extracted information on (1) patient characteristics and cli ...[more]

PMID: 24586242

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Project description:BackgroundPosterior urethral valves (PUV) may cause subtle to severe obstruction of the urethra, resulting in a broad clinical spectrum. PUV are the most common cause of chronic renal disease in boys. Our purpose was to report the incidences of kidney and bladder dysfunction in boys treated with endoscopic valve resection for PUV.MethodologyWe searched MEDLINE and EMBASE databases until 1st of July 2011, to identify original papers that described outcome of endoscopic valve resection (EVR) in boys. We extracted information on (1) patient characteristics and clinical presentation of PUV related to outcomes and (2) the post-treatment absolute risks for kidney and bladder dysfunction.Principal findingsThirty-four studies describing renal function, vesicoureteral reflux (VUR), incontinence, and urodynamic bladder function after EVR in 1474 patients were retrieved. Patients treated for PUV show high percentages of chronic kidney disease (CKD) or end stage renal disease (ESRD), 22% (0-32%) and 11% (0-20%), respectively. Elevated nadir serum creatinine was the only independent factor associated with renal failure. Before treatment, VUR was present in 43% of boys and after EVR, VUR was present in 22%. Post treatment, 19% (0-70%) was reported to suffer from urinary incontinence. Urodynamic bladder dysfunction was seen in many patients (55%, 0-72%) after treatment of PUV.ConclusionsThe reported cumulative incidence of renal and bladder dysfunction in patients with PUV after endoscopic PUV treatment varies widely. This may reflect a broad clinical spectrum, which relates to the lack of a standardised quantification of obstruction and its severity. Moreover, the risk of bias is rather high, and therefore we put little confidence in the reported estimates of effect. We found elevated nadir serum creatinine as a predictor for renal dysfunction. In order to be able to predict outcomes for patients with PUV, an objective classification of severity of obstruction is mandatory.

Project description:AimsThe objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction.MethodsWe conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria.ResultsThe analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure.ConclusionThe superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a "familiar approach" for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro-anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.

Dataset Information

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys.

Background

Methodology

Principal findings

Conclusions

Publications

A systematic review on the accuracy of diagnostic procedures for infravesical obstruction in boys.

Similar Datasets

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