Introduction: Cystography under general anesthesia has proven a safe procedure in several studies. Some radiologists prefer to insert the catheter and perform examinations under anesthesia for their and the child's convenience. This study compares cystography under light sedation to cystography under general anesthesia.
Methods: A prospective study of children who had vesicoureteral reflux (VUR) on cystography without general anesthesia, and underwent endoscopic injection of bulking agent into the ureter. Pre-operative clinical and radiological data were recorded. All children subsequently underwent a cystography under general anesthesia prior to injection using standardized method, which included bladder filling to iliac crest level, and external abdominal pressure to look for active reflux. This cystography was compared to cystography performed without general anesthesia. Chi-square and Mann–Whitney U tests were used to compare proportions and medians between groups
Results: Between October 2017 and January 2021, 92 renal units in 8 boys and 38 girls were evaluated. Median age was 3 years (IQR 1.5, 5). Median time from cystography without to cystography with general anesthesia was 3.7 months (IQR 2.6, 5.9).
Of the 92 renal units, 73 had VUR on cystography without general anesthesia, considered as gold standard. VUR grades by the gold standard are presented in Table 1.
VUR grade
Number of renal units
I
4
II
10
III
28
IV
27
V
4
Total
73
On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative predictive value and positive predictive value of cystography with general anesthesia were 41% (30/73), 79% (15/19), 26% (15/58), and 88% (30/34) (Table 2).
cystography without general anesthesia
Any VUR
No VUR
Total
cystography with general anesthesia
Any VUR
30
4
34
No VUR
43
15
58
Total
73
19
92
Cohen’s Kappa coefficient between the two cystography was 0.11, indicating poor agreement.
In subgroup analyses, the sensitivity of cystography with general anesthesia for filling phase VUR was 45% (29/64) vs. 11% (1/9) for voiding phase VUR, (P=0.05).
Conclusions: Cystography with general anesthesia was poorly correlated to cystography performed while the child was lightly sedated. Clinical decision relying on this cystography is questionable.
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