title: Voiding cystourethrogram--are our protocols the same?
abstract: OBJECTIVE
  Voiding cystourethrogram is the gold standard for evaluating and diagnosing vesicoureteral reflux. Reflux detection can potentially be affected by many parameters during voiding cystourethrogram.
  
  
  METHODS
  A 29-item survey was sent via e-mail through SurveyMonkey® to the chairperson of pediatric radiology at 65 national pediatric hospitals. This survey included questions on institutional protocols for performing voiding cystourethrogram.
  
  
  RESULTS
  Responses were received from 41 institutions from across North America, including 17 of 19 Randomized Intervention for Children with Vesicoureteral Reflux study sites. Many aspects of the reports of voiding cystourethrogram protocols were similar with 90% or greater agreement in allowing parents in the room, contrast infusion by gravity, catheter or feeding tube use without balloons, no contrast dilution and voiding without a catheter in place. The height at which contrast medium was raised for infusion was 40, 60, 80, 100 and greater than 100 cm at 2.4%, 17.1%, 17.1%, 39.0% and 12.2% of sites, respectively, while the height was not measured or it varied at 12.2%. The infilling phase stopped when the bladder appeared full at 2.4% of sites, infusion stopped itself at 12.2%, patient voided at 61.0%, volume attained age expected capacity at 12.2%, the patient was uncomfortable at 4.9% and results varied at 7.3%.
  
  
  CONCLUSIONS
  Data reveal that voiding cystourethrogram is performed differently across North America and no standard protocol exists for the procedure. These differences could significantly impact voiding cystourethrogram results among institutions and taint our ability to compare results in the literature.
authors.affiliation: Department of Urology and Radiological Sciences, College of Medicine, FGR, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. Blake-Palmer@ouhsc.edu
authors.forename: Blake W
authors.initials: BW
authors.lastname: Palmer
authors.forename: Faridali G
authors.initials: FG
authors.lastname: Ramji
authors.forename: Charles T
authors.initials: CT
authors.lastname: Snyder
authors.forename: Michael
authors.initials: M
authors.lastname: Hemphill
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Kropp
authors.forename: Dominic
authors.initials: D
authors.lastname: Frimberger
mesh_terms: D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D009656:North America; D015203:Reproducibility of Results; D014554:Urination; D014567:Urography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000503:physiopathology