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Pecorelli S, Ferdynus C, Delmas J, Harper L. Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings. Front Pediatr 2024; 12:1380502. [PMID: 38699154 PMCID: PMC11063334 DOI: 10.3389/fped.2024.1380502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Bladder profile in boys with Posterior Urethral Valves can be very varied with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal. Our question was whether appearance, specifically of the bladder, on initial VCUG was correlated to prenatal features and whether it could predict early postnatal outcome. Method We used a prospectively gathered database of boys with prenatally suspected PUV. We analyzed whether the appearance, specifically of the bladder, was related to date of prenatal diagnosis, presence of a megacystis on prenatal ultrasound, presence of vesico-ureteral reflux (VUR), presence of abnormal DMSA scan, nadir creatinine or presence of febrile urinary tract infection (fUTI) during the first two years of life. Results The database comprised 90 cystograms. 15% of bladders were judged normal/regular, 54 % were small/diverticular and 31% were large/diverticular. Bladder appearance was not associated with presence of prenatal megacystis, abnormal DMSA scan, VUR, nor rate of fUTI. The only significant associations were normal/regular bladder and early prenatal diagnosis (p = 0.04) and normal/regular bladder and elevated nadir creatinine (>75µmol/l) (p = 0.01). Discussion We believe that when focusing solely on the appearance of the bladder, excluding information about the urethra and presence of reflux, the cystogram alone is insufficient to inform on future bladder function. This could be used as an argument in favor of performing early urodynamics in this population.
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Affiliation(s)
- S. Pecorelli
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - C. Ferdynus
- Methodological SupportUnit, Reunion University Hospital, La Réunion, France
- Clinical Informatics Department, Reunion University Hospital, La Réunion, France
- Clinical Research Department, INSERM CIC1410, La Réunion, France
| | - J. Delmas
- Department of Pediatric Radiology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - L. Harper
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
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Mo Z, Li M, Xie X, Sun N, Zhang W, Tian J, Song H. Urodynamic changes before and after endoscopic valve ablation in boys diagnosed with the posterior urethral valve without chronic renal failure. BMC Urol 2023; 23:5. [PMID: 36609250 PMCID: PMC9824914 DOI: 10.1186/s12894-022-01170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Current research on the posterior urethral valve (PUV) mainly focuses on the follow-up of bladder function after valve ablation. However, few studies exist on the changes in bladder function before and after valve ablation. OBJECTIVES To investigate the urodynamic changes before and after PUV ablation and determine the effect of operation on bladder function, in patients. MATERIALS AND METHODS The clinical records of 38 boys diagnosed with PUV and undergone urodynamic exams before and after valve ablation were retrospectively reviewed. In addition, differences in patients' radiographic studies and urodynamic characteristics between pre- and post-operation were evaluated. Moreover, the urodynamic data was compared using the paired t-test and all the data was expressed as means ± SEM. Additionally, p values less than 0.05 were considered to be statistically significant. RESULTS All the patients were diagnosed with PUV and the follow-up period after operation ranged between 9 and 114 months. The urodynamic exams were performed about 6 months after operation. The results revealed that bladder compliance improved from 8.49 ± 4.73 to 13.31 ± 6.78 ml/cmH2O while the maximum detrusor pressure decreased from 95.18 ± 37.59 to 50.71 ± 21.71 cmH2O, after valve ablation. Additionally, there were significant differences in the pre- and post-operation values of bladder compliance and maximum detrusor pressure (p < 0.05). However, there were no significant differences in the pre- and post-operation values with regard to the residual urine volume, maximum bladder volume and maximum urinary flow rate (p > 0.05). CONCLUSIONS The adequacy of the COPUM incision is necessary. But the study showed that endoscopic valve ablation couldn't by itself completely improve the bladder function of patients diagnosed with PUV. However, it was able to improve bladder compliance and decrease maximum detrusor pressure to a certain extent. However, bladder compliance still couldn't reach the normal level.
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Affiliation(s)
- Zhiqiang Mo
- grid.411609.b0000 0004 1758 4735Urology Department, Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital, Beijing, China
| | - Minglei Li
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xianghui Xie
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ning Sun
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Weiping Zhang
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jun Tian
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hongcheng Song
- grid.411609.b0000 0004 1758 4735Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
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Babu R. Editorial comment on "Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves". J Pediatr Urol 2022; 18:820. [PMID: 35948452 DOI: 10.1016/j.jpurol.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
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Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 2022; 18:813-819. [PMID: 35840456 DOI: 10.1016/j.jpurol.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood. Bladder and posterior urethral deformity in infants with PUV are highly variable on initial voiding cystourethrogram (VCUG). Some types of deformity may be more important than others in determining the severity of the condition. Identification of specific VCUG features may allow for a simple, early screening assessment for patients. OBJECTIVE Determine whether morphologic features on the initial VCUG correlate to renal outcomes as measured by the creatinine nadir in the first year after ablation. METHODS Children with PUV treated by primary valve ablation before 12 months old and followed >1 year were identified. Initial diagnostic VCUG was evaluated for the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), and posterior-anterior urethral ratio (PA-UR). A trabeculation grade was assigned by three pediatric urologists, and reflux was noted. Univariable analyses with chi-square and t-test were used to compare bladder and posterior urethral morphology factors among those who obtained a creatinine nadir <0.8 or ≥0.8 mg/dL in the first year after ablation. Linear regression was performed to correlate morphology values with true creatinine nadir. RESULTS A total of 120 boys were ablated at mean age of 40.5 days (range 0-342) and followed for 5.9 years (± 3.85). Among these, 21 (17.5%) had a creatinine nadir ≥0.8 mg/dL. Mean overall HW-B and mean PA-UR were not significantly different between those with creatinine nadir <0.8 versus ≥0.8 mg/dL. Bladder trabeculation grade was not associated with creatinine nadir. For the entire cohort, only the difference in HW-PU was statistically significant between creatinine nadir groups with a much higher ratio among those with a nadir ≥0.8 (p < 0.001). Linear regression demonstrated a significant positive correlation between the HW-PU and creatinine nadir (R 2 = 0.097, p = 0.002). The presence of bilateral reflux is significantly associated with creatinine nadir ≥0.8 mg/dL (p = 0.001). DISCUSSION We investigate for the first time the association of morphology features on the initial VCUG with renal outcome in PUV patients. Posterior urethral deformity as quantified by a higher HW-PU ratio is significantly correlated with a higher creatinine nadir, whereas measured bladder morphology metrics are not. HW-PU may be an indirect measure of the severity of obstruction in posterior urethral valves. CONCLUSION The HW-PU appears to be a meaningful early morphologic metric for renal outcome.
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Babu R, Sai V. Bladder height width ratio on voiding cystourethrogram as a predictor of future valve bladder in children with posterior urethral valve. Pediatr Surg Int 2022; 38:935-939. [PMID: 35419631 DOI: 10.1007/s00383-022-05121-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND/AIMS Prompt and early treatment of valve bladder is known to improve renal outcome in patients with PUV. We hypothesized that bladder height width ratio (HWR) measurement on voiding cystourethrogram (VCUG) could predict development of valve bladder. METHODS All patients who underwent primary PUV ablation and evaluated later with urodynamics were included. Valve bladder was suspected when there were daytime wetting, persistent hydroureteronephrosis, and elevated detrusor pressures on urodynamics. VCUGs were analysed for HWR: maximum height/width of bladder. ROC curve analysis was performed to identify HWR that could predict development of urodynamic abnormality. RESULTS Between 2012 and 2017, 102 patients were studied: median age at valve ablation 25 days (3-125 days); follow-up 5 years (3-7 years). The ROC curve comparing post-ablation HWR with occurrence of valve bladder showed a cut-off of 1.45 (AUC 0.93). HWR cut-off of 1.45 had a sensitivity of 89% and specificity of 84% in predicting future valve bladder. Detrusor overactivity was noticed on urodynamics in 41/55 (74%) of those with HWR > 1.45 compared 5/47 (11%) in those with HWR < 1.45 (p = 0.001). CONCLUSION Bladder height width ratio on VCUG is a useful parameter to predict development of future valve bladder in children with PUV.
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Affiliation(s)
- Ramesh Babu
- Pediatric Urology Unit, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
| | - Venkata Sai
- Departments of Pediatric Urology and Radiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India
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Safety and short-term efficacy of mirabegron in children with valve bladder: a pilot study. Pediatr Surg Int 2022; 38:493-498. [PMID: 34859277 DOI: 10.1007/s00383-021-05040-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
AIMS This pilot study aims to assess the short-term efficacy and safety of mirabegron in valve bladder, an important cause of persistent hydronephrosis after successful treatment of posterior urethral valves (PUV). METHODS Twenty-two patients with early valve bladder (no residual PUV; persistent hydronephrosis, wetting and urodynamic evidence of detrusor overactivity) were included. Three subjective parameters: frequency, wetting episodes; patient perception of bladder condition score (PPBC) and four objective parameters: uroflow index (UI = Qave/Qmax), voided volume (VV = voided volume/ expected bladder capacity), maximum filling pressure (P det-max) and society of fetal urology (SFU) hydronephrosis grading were analysed pre- and post-3-month treatment with mirabegron (0.5-1 mg/kg/day). All patients were observed for heart rate, BP, ECG changes during therapy. RESULTS There was significant reduction (p = 0.001) in mean frequency (pre 15; post 10), wetting episodes (pre 5; post 2) and PPBC (pre 4; post 3). There was significant improvement (p = 0.01) in mean UI (pre 0.3; post 0.5), VV (pre 0.54; post 0.72), Pdet-max (pre 42; post 25) and hydronephrosis grade (pre 3.5; post 2.2). There were no significant side effects. CONCLUSION This pilot study establishes short-term efficacy and safety of mirabegron in valve bladder with overactivity. Further larger long-term studies are warranted.
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Hofmann A, Haider M, Cox A, Vauth F, Rösch WH. Is Vesicostomy Still a Contemporary Method of Managing Posterior Urethral Valves? CHILDREN 2022; 9:children9020138. [PMID: 35204859 PMCID: PMC8869788 DOI: 10.3390/children9020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
In boys with posterior urethral valves (PUVs) the main treatment aim is to preserve long-term bladder and renal function. To determine the effectiveness of secondary vesicostomy in boys with PUVs, the medical records of 21 patients with PUV (2010–2019), divided into two groups (group I: valve ablation; group II: secondary vesicostomy), were reviewed regarding the course of serum creatinine, renal ultrasound, voiding cystourethrogram, urodynamics, postoperative complications, need of further surgery, and long-term solution. The median age of all patients at first follow-up was 11 (9–13) months and at last follow-up 64.5 (39.5–102.5) months. Despite a significant difference of the SWDR score (shape, wall, reflux, and diverticula) (p = 0.014), both groups showed no significant differences preoperatively. Postoperatively, serum creatinine (p = 0.024), grade of vesicoureteral reflux (p = 0.003), side of upper tract dilatation (p = 0.006), side of megaureter (p = 0.004), and SWDR score (p = 0.002) were significantly decreased in group II. Postoperative urodynamic measurements showed comparable results in both groups. Stoma complications were found in three (20%) patients (group II). Eight (53.3%) patients already received a closure of the vesicostomy. Seven out of eight (87.5%) patients were able to micturate spontaneously. Vesicostomy remains a reliable treatment option for boys with PUV to improve bladder function and avoid further damage to the urinary tract.
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Affiliation(s)
- Aybike Hofmann
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, 93049 Regensburg, Germany; (A.C.); (F.V.); (W.H.R.)
- Correspondence:
| | | | - Alexander Cox
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, 93049 Regensburg, Germany; (A.C.); (F.V.); (W.H.R.)
- Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Franziska Vauth
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, 93049 Regensburg, Germany; (A.C.); (F.V.); (W.H.R.)
| | - Wolfgang H. Rösch
- Department of Pediatric Urology, Clinic St. Hedwig, University Medical Center Regensburg, 93049 Regensburg, Germany; (A.C.); (F.V.); (W.H.R.)
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Gaibie Z, Mahomed N, Petersen KL, Moonsamy G, Bokhari AA, Adam A. Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children? SA J Radiol 2020; 24:1820. [PMID: 32670630 PMCID: PMC7343929 DOI: 10.4102/sajr.v24i1.1820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/18/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. OBJECTIVES We aimed to review the role of the 'ideal' ratio on predicting residual PUV post-ablation. METHODS A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included 'Urethral Ratio and Posterior urethral valve ablation'. All cited reference lists were further evaluated for additional inclusive studies. RESULTS Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5-3 and 3.5. CONCLUSION Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2-3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.
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Affiliation(s)
- Zakiyah Gaibie
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa
- Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
| | - Nasreen Mahomed
- Department of Radiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen L. Petersen
- Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatric Nephrology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Glenda Moonsamy
- Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatric Nephrology, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Akram A.H. Bokhari
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa
- Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
- Department of Urology, College of Medicine, Hail University, Hail, Saudi Arabia
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Ahmed Adam
- Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Urology, Helen Joseph Hospital, Johannesburg, South Africa
- Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
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Valve Bladder Syndrome Associated with Posterior Urethral Valves: Natural History, Work-up, and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Neyas A, Bajaba R, AlThomali R, Alturkistani R, AlSawaf B, Alrefai W, Hefni L, Aldoobie L, Desoky S, Kari J, Safdar OY. Correlation between the estimated GFR and SWRD score in patients with posterior urethral valves at King Abdul-Aziz University Hospital. BMC Res Notes 2019; 12:81. [PMID: 30755266 PMCID: PMC6373006 DOI: 10.1186/s13104-019-4120-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The aim was to establish the reliability of the SWRD score as a predictor of both renal and bladder outcomes in posterior urethral valves. This retrospective study included 67 patients with PUVs at King Abdul-Aziz University Hospital. The score was calculated from voiding cystourethrogram before and after the relief of obstruction, and estimated glomerular filtration rates (eGFRs) were calculated as well. Results Based on Spearman correlations, both baseline eGFRs and SWRD scores can be possible predictors of long-term renal outcomes, as a significant positive correlation between the baseline eGFRs and the last eGFRs was found (p = 0.005). A significant negative correlation was also found between the SWRD score calculated before the intervention and the last eGFRs (p = 0.02). Additionally, the baseline SWRD scores can be possible predictors of short-term bladder outcomes, as the correlation analysis showed a positive relationship between the baseline SWRD scores and the SWRD scores calculated within 2 months after the intervention (p < 0.0001). A significant decrease in SWRD scores and eGFRs was found from before to after the intervention, regardless of the type of intervention. In conclusion, the SWRD scoring system proved to be a potentially promising tool in the anticipation of the clinical outcomes of PUVs.
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Affiliation(s)
- Afnan Neyas
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Rana Bajaba
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf AlThomali
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf Alturkistani
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Baraah AlSawaf
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Weaam Alrefai
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lujain Hefni
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lamees Aldoobie
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif Desoky
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jameela Kari
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y Safdar
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
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Mitchell M. Commentary on "Cystometrogram appearance in PUV is reliably quantified by the SWRD score, and presages the need for intervention". J Pediatr Urol 2017; 13:266. [PMID: 28209393 DOI: 10.1016/j.jpurol.2016.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Mitchell
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
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