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Is Having a VCUG that Horrible: Assessment of Parental Satisfaction in Children Undergoing Voiding Cystourethrography
Brian J. Minnillo, MD, Andres D Silva, MD, Frank J. Penna, MD, Jeanne S. Chow, MD, Angela M. Franceschi, Med, CCLS, Sonja Ziniel, PhD, Natascha Sandy, BS, Hiep T. Nguyen, MD
Children's Hospital Boston, Boston, MA, USA.

BACKGROUND: Voiding cystourethrography (VCUG) is the gold standard in the diagnosis of vesicoureteral reflux and a number of other bladder conditions. An estimated 50,000 children undergo this procedure every year. There is a recent trend toward the use of sedation or even delaying or forgoing VCUG due to the anticipated distress of the exam. We hypothesized that VCUG is not as distressing as commonly thought and can be performed without the need for sedation with adequate preparation and the use of proper techniques to minimize anxiety.
METHODS: A prospective evaluation of parental satisfaction of children undergoing VCUG was conducted using the 33-question VCUG Satisfaction Survey. Sixty-one parents of patients of all ages (53% male) completed the survey in urology clinic after undergoing a VCUG earlier that day. The questions assessed level of preparation, parental satisfaction, sources of discomfort, and the value of a child life specialist (CLS).
RESULTS: Fifty-two percent of the children were under one year of age. Most parents reported being prepared for the procedure, while only 6% reported not being very prepared. Most parents found discussions with the radiologist and primary care physician prior to the exam to be useful. The more prepared the parents were the greater percentage reported being very satisfied with the procedure.
About one-third of patients had a prior VCUG, with more than two-thirds of these having their prior VCUG at our institution, with one quarter reporting a much better experience and all reporting that that the recent VCUG was either the same or better than the prior VCUG. More than half reported that VCUG was the same or better than a physical exam, immunization, ultrasound, and prior catheterization. Most patients were uncomfortable during the catheter placement and bladder-filling phase but reported feeling comfortable after the procedure.
Two thirds of patients reported the presence of a CLS; however, 15% were unsure if a CLS was present. Most patients reported that the CLS was either extremely or very helpful for the child, the parent, and the physician present. Parents had varied perceptions of their own ability in comforting their child, whereas parents with a CLS present reported it to be much easier to comfort their child, with more than 70 percent reporting it to be somewhat or very easy. A greater percentage of parents with a CLS present than those without a CLS present reported being very satisfied. Most parents were very satisfied with the overall experience and their child’s ability to tolerate the procedure. Most parents reported that the VCUG experience was much better or better than expected, with only 5% reporting that the experience was worse than expected.
CONCLUSIONS: The VCUG, with adequate preparation and the support of a CLS, is a very tolerable procedure that exceeds expectations.


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