Ureter Visualization With Transvaginal Ultrasound: A Learning Curve Study.
endometriosis
learning curve
transvaginal ultrasound
ureter visualization
ureteral endometriosis
urinary tract endometriosis
Journal
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
ISSN: 1550-9613
Titre abrégé: J Ultrasound Med
Pays: England
ID NLM: 8211547
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
09
03
2020
revised:
24
04
2020
accepted:
01
05
2020
pubmed:
31
5
2020
medline:
15
5
2021
entrez:
31
5
2020
Statut:
ppublish
Résumé
To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2365-2372Subventions
Organisme : Research Foundation
Organisme : GE Healthcare
Informations de copyright
© 2020 American Institute of Ultrasound in Medicine.
Références
Barra F, Scala C, Biscaldi E, et al. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update 2018; 24:710-730.
Gupta A, Gupta P, Manaktala U. Varied clinical presentations, the role of magnetic resonance imaging in the diagnosis, and successful management of cervical leiomyomas: a case-series and review of literature. Cureus 2018; 10:e2653.
Ang C, Naik R. The value of ureteric stents in debulking surgery for disseminated ovarian cancer. Int J Gynecol Cancer 2009; 19:978-980.
Carmignani L, Vercellini P, Spinelli M, Fontana E, Frontino G, Fedele L. Pelvic endometriosis and hydroureteronephrosis. Fertil Steril 2010; 93:1741-1744.
Freire MJ, Dinis PJ, Medeiros R, Sousa L, Águas F, Figueiredo A. Deep infiltrating endometriosis: urinary tract involvement and predictive factors for major surgery. Urology 2017; 108:65-70.
Nezhat C, Paka C, Gomaa M, Schipper E. Silent loss of kidney secondary to ureteral endometriosis. JSLS 2012; 16:451-455.
Comiter CV. Endometriosis of the urinary tract. Urol Clin North Am 2002; 29:625-635.
Xiang H, Chan M, Brown V, Huo YR, Chan L, Ridley L. Systematic review and meta-analysis of the diagnostic accuracy of low-dose computed tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol 2017; 61:582-590.
Pooler BD, Lubner MG, Kim DH, et al. Prospective trial of the detection of urolithiasis on ultralow dose (sub mSv) noncontrast computerized tomography: direct comparison against routine low dose reference standard. J Urol 2014; 192:1433-1439.
Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2013; 189:1203-1213.
Somani BK, Dellis A, Liatsikos E, Skolarikos A. Review on diagnosis and management of urolithiasis in pregnancy: an ESUT practical guide for urologists. World J Urol 2017; 35:1637-1649.
Elias J Jr. Ureterolithiasis and the quest for rational use of diagnostic imaging methods. Radiol Bras 2018; 51:VII-VIII.
Pateman K, Mavrelos D, Hoo WL, Holland T, Naftalin J, Jurkovic D. Visualization of ureters on standard gynecological transvaginal scan: a feasibility study. Ultrasound Obstet Gynecol 2013; 41:696-701.
Bean E, Naftalin J, Jurkovic D. How to assess the ureters during pelvic ultrasound. Ultrasound Obstet Gynecol 2019; 53:729-733.
Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48:318-332.
Leonardi M, Condous G. How to perform an ultrasound to diagnose endometriosis. Australas J Ultrasound Med 2018; 21:61-69.
Leonardi M, Martins WP, Espada M, Arianayagam M, Condous G. Proposed technique to visualize and classify uterosacral ligament deep endometriosis with and without infiltration into parametrium or torus uterinus. Ultrasound Obstet Gynecol 2020; 55:137-139.
Leonardi M, Singh SS, Murji A, et al. Deep endometriosis: a diagnostic dilemma with significant surgical consequences. J Obstet Gynaecol Can 2018; 40:1198-1203.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of ultrasound of the female pelvis. J Ultrasound Med 2014; 33:1122-1130.
American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. J Ultrasound Med 2012; 31:133-144.
Leonardi M, Ong J, Espada M, et al. One-size-fits-all approach does not work for gynecology trainees learning endometriosis ultrasound skills. J Ultrasound Med. In press. https://doi.org/10.1002/jum.15337.
European Federation of Societies for Ultrasound in Medicine and Biology. Minimum training recommendations for the practice of medical ultrasound, appendix 3: gynaecological ultrasound. Ultraschall Med 2006; 27:79-105.
Reid S, Lu C, Casikar I, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol 2013; 41:685-691.
Pateman K, Holland TK, Knez J, et al. Should a detailed ultrasound examination of the complete urinary tract be routinely performed in women with suspected pelvic endometriosis? Hum Reprod 2015; 30:2802-2807.
Tammaa A, Fritzer N, Strunk G, Krell A, Salzer H, Hudelist G. Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod 2014; 29:1199-1204.
Piessens S, Healey M, Maher P, Tsaltas J, Rombauts L. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust NZ J Obstet Gynaecol 2014; 54:462-468.
Biau DJ, Williams SM, Schlup MM, Nizard RS, Porcher R. Quantitative and individualized assessment of the learning curve using LC-CUSUM. Br J Surg 2008; 95:925-929.
Aas-Eng MK, Salama M, Sevelda U, Ruesch C, Nemeth Z, Hudelist G. Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study. Ultrasound Obstet Gynecol 2020; 55:264-268.
Ordon M, Schuler TD, Ghiculete D, Pace KT, Honey RJDA. Stones lodge at three sites of anatomic narrowing in the ureter: clinical fact or fiction? J Endourol 2013; 27:270-276.
Yaqoob J, Usman MU, Bari V, Munir K, Mosharaf F. Unenhanced helical CT of ureterolithiasis: incidence of secondary urinary tract findings. J Pak Med Assoc 2004; 54:2-5.
Park SJ, Yi BH, Lee HK, Kim YH, Kim GJ, Kim HC. Evaluation of patients with suspected ureteral calculi using sonography as an initial diagnostic tool. J Ultrasound Med 2008; 27:1441-1450.
Young SW, Dahiya N, Patel MD, et al. Initial accuracy of and learning curve for transvaginal ultrasound with bowel preparation for deep endometriosis in a US tertiary care center. J Minim Invasive Gynecol 2017; 24:1170-1176.