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19–22 APRIL, 2017, BARCELONA, SPAIN
S25: NEUROPATHIC BLADDER 2
Moderators: Luis Garcia-Aparicio (Spain), Anju Goyal (UK)
ESPU Meeting on Saturday 22, April 2017, 12:40–13:36
12:40–12:43
S25-1 (PP)
★
A NOVEL GRADING SYSTEM FOR BLADDER
TRABECULATION IN PEDIATRIC PATIENTS WITH
NEUROGENIC BLADDERS
Blake SELBY
1
, Guy HIDAS
2
, Tandis SOLTANI
3
, Sherrie KAPLAN
4
, John BILLIMEK
4
,
Elias WEHBI
5
, Irene MCALEER
2
and Antoine KHOURY
2
1) CHOC Children’s Urology Center, Paediatric Urology, Orange, USA - 2) University of California, Irvine and the
Children’s Hospital of Orange County, Department of Urology, Orange, USA - 3) Michigan State University Medical
School, East Lansing, USA - 4) University California Irvine Health Policy Research Institute, Irvine, USA - 5) University
of California, Irvine and the Children’s Hospital of Orange County, Paediatric Urology, Orange, USA
PURPOSE
Bladder trabeculation is a common finding in pediatric patients with neurogenic bladders. There is
currently no standardized grading system used to describe the severity of bladder trabeculation. In
this study we developed and determined the reliability of a grading system using cystograms.
MATERIAL AND METHODS
The grading system was developed and designed by an expert panel pediatric urologists. The
grading system is based on the appearance of the bladder on cystogram. There are 3 grades with
a grade 0 as normal and grade 2 being severely trabeculated. A previous pilot study (n=9) showed
excellent intra and inter-rater reliability.
In this study, we enrolled 33 participants including pediatric urologist, fellows, urology residents and
nurse practitioners to rate 30 cystogram images representing the 3 grades of bladder trabeculation.
In order to calculate intra-rater reliability, 18 participants repeated this activity. Reliability was then
calculated using Spearman’s rank correlation coefficient, Cohen’s Kappa and intraclass correlation
coefficient.
RESULTS
All 33 participants were used to determine inter-rater reliability. This grading system showed a high
degree of inter-rater reliability with an intraclass correlation coefficient of 0.998 (p<0.001). In ad-
dition, this was further confirmed with a Cohen’s Kappa ranging between 0.795-1.0 (p<0.001).
The Spearman’s rank correlation coefficient ranged between 0.910-1.0, (p<0.001), showing good
intra-rater reliability.
CONCLUSIONS
This novel grading system for bladder trabeculation shows excellent inter and intra-rater reliability.
This tool may potentially improve communication both clinically and within future research involving
patients with neurogenic bladders. However, further validation studies are required.