Distress experienced during pediatric VCUGs – a granular, prospective assessment using the brief behavioral distress scale

Abstract

We find that despite there being significantly increased distress during the catheter insertion and full bladder phases, the distress levels during VCUGs are markedly less than in previous reports. Even the most distressful stage, catheterization, was less stressful than previously reported with levels closer to that of minor distress evinced by comfort-seeking behavior from a parent rather than more significant distress resulting in screaming. Our findings corroborate and expand on the conclusion of the effectiveness of pretest preparation and child life specialist involvement.

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

“…VCUG is painful and unpleasant, with urethral catheterization and voluntary voiding in public. After catheterization and filling the bladder with contrast medium, the patient must void in front of the X‐ray camera, which causes anxiety for patients and families . More than half the children undergoing VCUG remember it as worse than VUR surgery .…”

“…Urethral catheterization is the most distressing part of the procedure, because children are usually unable to relax enough to void during VCUG . Because radiation exposure during VCUG and computed tomography might increase cancer risk, radiation dose reduction or elimination is preferable.…”

“…It is important to include specialists with much experience in child development, education, and psychosocial care of children and families receiving painful medical care, such as VCUG . Pretest preparation for obtaining informed consent benefits from child‐life specialist involvement to reduce patient distress . The provision of favorite cartoon videos, video games, smart phones and personal items helps to distract the patient during VCUG.…”

“…After catheterization and filling the bladder with contrast medium, the patient must void in front of the X-ray camera, which causes anxiety for patients and families. 9,[27][28][29] More than half the children undergoing VCUG remember it as worse than VUR surgery. 30 This is an extremely humiliating experience for toilet-trained children, because they are educated to void in the restroom.…”

“…Urethral catheterization is the most distressing part of the procedure, because children are usually unable to relax enough to void during VCUG. 29,32 Because radiation exposure during VCUG 33 and computed tomography 34 might increase cancer risk, radiation dose reduction or elimination is preferable. Children's developing tissues and organs are approximately 10-fold more sensitive to ionizing radiation than adults, 35 and mean risks for hereditary effects and cancer after VCUG during childhood have been estimated at 15 per million and 125 per million, respectively.…”