Summary
Introduction
Bladder ultrasound is becoming pivotal in the management and treatment of lower urinary
tract dysfunction. There is a paucity of data regarding intra-observer and interobserver
reliability of bladder ultrasound, especially in children. A previous study assessed
interobserver agreement for both the postvoid residual volume and measurement of the
bladder dimensions in adults showing excellent agreement.
Objective
To examine the interobserver and intra-observer reliability of bladder wall thickness,
bladder urinary and postvoid residual urinary volume using ultrasound evaluated by
paediatricians having different training levels.
Study design
Four sonographers, 3 pediatric trainees and one experienced pediatric urologist measured
the full bladder volume, the voiding residual volume, and the bladder wall thickness.
Each sonographer made 3 measurements of each parameter. We assessed the interobserver
and intra-observer variability by using intraclass correlations (ICCs). ICCs were
calculated and tested with a significance level of 5%. The interrater ICC was calculated
from the mean of the three measurements of each variable (full bladder volume, postvoid
residual, bladder wall thickness). ICC ≥0.75 was considered excellent. Bland-Altman
plots were also used to assess the interobserver agreement.
Results
Sixty children were recruited (7.3 ± 1.1 years). The interobserver ICCs for bladder
volume and voiding residual volume were 0.91 (confidence interval 0.85–0.95) for both.
The interobserver ICCs for the bladder wall thickness was satisfactory 0.43, with
a minimum detectable difference of 2 mm. The observed values for intra-observer analysis
showed an excellent (ICC ≥ 0.90) agreement between the three measurements performed
by each one of the sonographers. Bland-Altman plots showed that the bias (mean difference)
was −0.35 and the limits of agreement were −3.43 and 2.73 for the bladder wall thickness
measurements (Figure).
Discussion
The interobserver reliability for both the postvoid residual volume and full bladder
volume were excellent even in operators with different levels of training, pointing
out the role of bladder ultrasound in the routine clinical practice. Weaker agreement
was found for the bladder wall thickness measurement. The intra-observer agreement
was excellent for all the measurements.
Conclusion
These results showed a good reliability of urinary bladder ultrasound in children
aged 7.3 ± 1.1 years as far as bladder volume measurement is concerned. Given the
variability of bladder wall thickness, a standardized methodology is desirable to
increase its reliability.
Keywords
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References
- The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children’s Continence Society.J Urol. 2014; 191 (e13): 1863-1865https://doi.org/10.1016/j.juro.2014.01.110
- Correlations between enuresis in children and nocturia in mothers.Scand J Urol Nephrol. 2010; 44: 101-105https://doi.org/10.3109/00365590903510737
- Daytime urinary incontinence in children and adolescents.Lancet Child Adolesc Heal. 2019; 3: 492-501https://doi.org/10.1016/S2352-4642(19)30113-0
- Ultrasonographic bladder measurements can replace urodynamic study for the diagnosis of non-monosymptomatic nocturnal enuresis.BJU Int. 2010; 105: 108-111https://doi.org/10.1111/j.1464-410X.2009.08735.x
- Desmopressin and oxybutynin in monosymptomatic nocturnal enuresis: a randomized, double-blind, placebo-controlled trial and an assessment of predictive factors.BJU Int. 2012; 110: E381-E386https://doi.org/10.1111/j.1464-410X.2011.10918.x
- Clinical features of, and association of bladder ultrasound and uroflowmetry with, overactive bladder recovery period in children.Pediatr Int. 2018; 60: 569-575https://doi.org/10.1111/ped.13577
- Intra- and inter-rater reliability of post-void residual bladder volume with ultrasound.Int Urogynecol J. 13 July 2019; (Published Online First)https://doi.org/10.1007/s00192-019-04045-1
- Extraordinary daytime only urinary frequency in childhood: prevalence, diagnosis, and management.J Pediatr Urol. 2018; (Published Online First)https://doi.org/10.1016/j.jpurol.2017.12.005
- Accuracy of ultrasonic assessment of residual urine in children.Pediatr Radiol. 1989; 19: 388-390https://doi.org/10.1007/bf02387634
- Sample size requirements for estimating intraclass correlations with desired precision.Stat Med. 2002; 21: 1331-1335https://doi.org/10.1002/sim.1108
- Designing clinical research : an epidemiologic approach.2nd ed. Lippincott Williams & Wilkins, Philadelphia2001
- Age- and gender-specific nomograms for single and dual post-void residual urine in healthy children.Neurourol Urodyn. 2013; 32: 1014-1018https://doi.org/10.1002/nau.22342
- Elevated postvoid residual urine volume predicting recurrence of urinary tract infections in toilet-trained children.Pediatr Nephrol. 2015; 30: 1131-1137https://doi.org/10.1007/s00467-014-3009-y
- Do uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?.Int Braz J Urol. 2018; 44: 805-811https://doi.org/10.1590/S1677-5538.IBJU.2017.0464
- Utility of bedside bladder ultrasound before urethral catheterization in young children.Pediatrics. 2005; 115: 108-111https://doi.org/10.1542/peds.2004-0738
- Success rate of BladderScan-assisted suprapubic aspiration.Emerg Med Australasia (EMA). 2012; 24: 647-651https://doi.org/10.1111/1742-6723.12011
- Ultrasound bladder measurements in children with severe primary nocturnal enuresis: pretreatment and posttreatment evaluation and its correlation with treatment outcome.J Urol. 2008; 179 (discussion 1572): 1568-1572https://doi.org/10.1016/j.juro.2007.11.096
- Standardized ultrasound method for assessing detrusor muscle thickness in children.J Urol. 2000; 164: 134-138
- Bladder wall thickness in the assessment of neurogenic bladder: a translational discussion of current clinical applications.Ann Transl Med. 2016; 4: 32https://doi.org/10.3978/j.issn.2305-5839.2015.10.22
Article info
Publication history
Published online: December 31, 2019
Accepted:
December 21,
2019
Received:
October 7,
2019
Identification
Copyright
© 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
