Randomised controlled trials (RCTs) that assessed pharmacological, psychological or other interventions for reducing pain and distress in children aged up to 18 years who underwent voiding cystourethrography were eligible for inclusion. Trials were eligible if interventions were compared with routine care, pharmacological treatments were compared with placebo or that compared alternative agents or different dosages of the same agent. Primary outcomes of interest were distress, pain or anxiety rated by the child, parents, clinicians, researchers or technician. Secondary outcomes included urological outcomes (time to micturation and post void residual volume), safety, duration of procedure, cost and radiation exposure.
All included trials were based at hospital/university. The mean age of children included in the studies was 4.7 years (range zero to 15 years). Three trials included infants under the age of one. Two trials reported participants' ethnic background (78.4% were white). Some trials included patients with a history of voiding cystourethrography. Interventions included cognitive-behavioural therapy, hypnosis, oral or nasal midazolam (0.2 to 0.6mg/kg), fentanyl or other interventions (contrast medium warmed). Comparators included standard or routine care (not defined), chloral hydrate, inhaled nitrous oxide 50%, contrast medium at room temperature and placebo (saline/sterile water). Primary outcomes were measured using various scales such as the Faces Pain Scale and visual analogue scale. None of the trials reported radiation dose.
Two reviewers independently screened studies for inclusion. Disagreements were resolved through discussion or referral to a third reviewer where discrepancies could not be resolved.