Analysis of Kidney Ultrasound Dimensions by Body Habitus and Position.

PURPOSE: Renal dimensions are an important assessment of the genitourinary tract used to evaluate critical aspects of renal growth and development. Understanding the effect of patient position is important to use and interpret these parameters. In this prospective study we determined the effect of patient position and general body habitus on renal length and parenchymal area in children undergoing renal ultrasound. MATERIALS AND METHODS: Between October 2010 and January 2011 children underwent renal ultrasound while prone and supine. Bilateral renal length and renal parenchymal area were measured. Pearson and Bland-Altman statistical analyses were used to examine correlations, measurement bias and the degree of agreement between methods. RESULTS: Renal length measurements in both positions were complete for 201 right and 196 left kidneys. Parenchymal area measurements were complete for both kidneys in 177 children. When compared individually, supine and prone measures of renal length and parenchymal area highly correlated on Pearson analysis (greater than 0.96 and greater than 0.89, respectively). When compared by method, Bland-Altman analyses of differences vs means showed greater than 50% variance, representing wide limits of agreement with poor interrelation. Neither persistent systematic bias nor body habitus influenced results. CONCLUSIONS: While Pearson analysis showed high correlation for supine and prone renal measurements, Bland-Altman analysis of renal length and parenchymal area demonstrated wide limits of agreement, not allowing interchangeable use of prone and supine measurements. As such, renal ultrasound should specify standardized positions and benchmarks. These results provide guidance to standardize renal ultrasound measurements when renal size is used as an indicator of kidney health.

Certification, recertification, and maintenance: continuing to learn.

The process of certification, recertification, and maintenance of certification is mandated by the American Board of Urology as a member Board of the American Board of Medical Specialties. The history of maintenance of certification parallels that of private regulation of medical schools and postgraduate medical education (residency) and other nonmedical areas in which public trust is involved. Current trends in information technology that allow data gathering that measure medical practice and recognition of failure mandate that urologists practice with current knowledge. This will be documented in the maintenance of certification process.

Management of delayed bladder augmentation perforation.

BACKGROUND: A 17-year-old male, with a history of bladder augmentation enterocystoplasty 7 years earlier, presented with nausea, emesis and acute abdomen. INVESTIGATIONS: Physical examination, blood and urine culture, and abdominal and pelvic CT cystography. DIAGNOSIS: Acute abdomen from perforation of bladder augmentation. MANAGEMENT: Support and stabilization, bladder decompression, and broad-spectrum intravenous antibiotics, followed by immediate exploratory laparotomy with repair of enterocystoplasty and peritoneal lavage.