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Ikhuoriah T, Oboh D, Abramowitz C, Musheyev Y, Shamsian E. Posterior urethral valve: A case report in an older Nigerian child. Radiol Case Rep 2023; 18:1715-1720. [PMID: 36895892 PMCID: PMC9989312 DOI: 10.1016/j.radcr.2023.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 03/03/2023] Open
Abstract
Posterior urethral valve (PUV) is an anomaly of the urinary tract in male children and is the leading cause of urinary tract obstruction in the pediatric population. PUV is diagnosed radiologically by ultrasonography, both pre- and postnatally, and using micturating cystourethrography. Its prevalence and age of diagnosis may vary by demographic and ethnic background. This case highlights an older Nigerian child that presented with recurrent urinary tract symptoms and was subsequently diagnosed with PUV. The study further explores the key radiographic findings and analyzes the radiographic imaging features of PUV in various populations.
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Affiliation(s)
- Teddy Ikhuoriah
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Old Westbury, NY 11545 USA
| | - David Oboh
- Medical Imaging Department, Prince Faisal Bin Khalid Cardiac Center (PFKCC), Abha, Aseer, Saudi Arabia
| | - Chiya Abramowitz
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Old Westbury, NY 11545 USA
| | - Yakubmiyer Musheyev
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Old Westbury, NY 11545 USA
| | - Ethan Shamsian
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Old Westbury, NY 11545 USA
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2
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Nsofor M, Riedesel EL, Cooley A. Right Flank Pain and Diurnal Enuresis in a 14-Year-Old Male. Clin Pediatr (Phila) 2022; 61:582-586. [PMID: 35549740 DOI: 10.1177/00099228221095450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maureen Nsofor
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Erica L Riedesel
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Division of Pediatric Radiology, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Anthony Cooley
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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3
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Yadav P, Rickard M, Kim JK, Richter J, Lolas M, Alshammari D, Chua ME, Dos Santos J, Lorenzo AJ. Comparison of outcomes of prenatal versus postnatal presentation of posterior urethral valves: a systematic review and meta-analysis. World J Urol 2022; 40:2181-2194. [PMID: 35943527 DOI: 10.1007/s00345-022-04097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes. METHODS We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible. RESULTS The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias. CONCLUSION The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Dheidan Alshammari
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon, Philippines
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Nishio H, Mizuno K, Kato T, Maruyama T, Yasui T, Hayashi Y. A case of posterior urethral valve identified in an older child by straining to void. Urol Case Rep 2021; 40:101886. [PMID: 34712583 PMCID: PMC8529502 DOI: 10.1016/j.eucr.2021.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022] Open
Abstract
Posterior urethral valves (PUVs) are the most common cause of congenital urethral obstruction. However, the diagnosis of a PUV is sometimes difficult. A 13-year-old Japanese boy and his mother visited our hospital, and his mother complained that he frequently strained to void although he had no complaint. Uroflowmetry revealed a plateau-shaped curve and a voiding cystourethrography (VCUG) revealed a PUV. Thus, we performed a transurethral incision of the PUV, and his voiding status improved. Because some patients with mild PUV may not notice their dysuria, we believe that VCUG should be performed without hesitation when a urethral lesion is suspected.
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Affiliation(s)
- Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taiki Kato
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuji Maruyama
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Alsaywid BS, Mohammed AF, Jbril SM, Bahashwan M, Mukharesh L, Al Khashan M. Renal outcome among children with posterior urethral valve: When to worry? Urol Ann 2021; 13:30-35. [PMID: 33897161 PMCID: PMC8052897 DOI: 10.4103/ua.ua_112_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/19/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Posterior urethral valve (PUV) is a congenital obstructive defect of male urethra that is diagnosed early during antenatal period with a presence of hydroureteronephrosis and associated with several morbidities including chronic kidney disease (CKD) that requires management, therefore, this study aim to evaluate the renal outcome of endoscopic valve ablation and urinary tract diversion in children with PUV, "when to worry, and what to do." METHODOLOGY This is a retrospective cohort study reviewing medical records of all patients diagnosed with PUV that has been managed in Pediatric Urology Unit at King Abdul-Aziz Medical City, Jeddah in the period of 1998-2008 with proven diagnosis at age younger than 16 accounted for 39 patients, and with different multiple demographics such as antenatal and postnatal ultrasound findings, serum levels of preoperative creatinine, mode of surgical treatment (i.e., endoscopic valve ablation and urinary diversions). Patients were divided into two groups according to the initial surgical intervention. Patient's characteristics and other variables were analyzed; t-test and Chi-square test were used. RESULTS During the follow-up period, (45%) developed CKD with a mean time of 5.5 years, 18% reach to end stage renal disease (ESRD), (10%) requiring dialysis. Abnormal creatinine level was detected in 69% (27/39) of our patients before the intervention and normalized in 97% after intervention. In comparison between the two intervention groups, CKD were developed in 60% of patients with urinary diversion in comparison to 33% for the endoscopic ablation group with no statistical significance with P = 0.09. The time to develop CKD was faster in the diversion group with mean age of 18 months (standard deviation [SD] 2 years) in comparison to endoscopic ablation group with mean age 6 years (SD 4 years). Similar results were observed for development of ESRD, patients who underwent diversion had slightly higher incidence of ESRD. In our cohort group, the main determinant for deterioration of the future kidney function was the level of serum creatinine, preoperatively. Moreover, recurrent urinary tract infections (UTIs) were developed in 64% of our cohort group and 49% of our population diagnosed with voiding dysfunction at 6 years of age. CONCLUSION A child with PUV who has a risk factor does have an increased potential of developing CKD, knowing that the type of intervention offered to treat PUV has no impact on the outcome. Furthermore, not having any of the study mentioned risk factors doesn't rule out the possibility of developing comorbidities which suggest that any child with PUV always need to be worried about and longer follow-up is indicated. Early intervention, check cystoscopy after ablation, close follow-up with appropriate laboratory and radiological investigation when necessary are recommended, and to improve the quality of data to the level reaching to a meaningful conclusion with high accuracy, a national database system from all centers across the country should be implemented.
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Affiliation(s)
- Basim Saleh Alsaywid
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- Department of Research and Development, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Research and Development Unit, Saudi Commission for Health Specialties, Jeddah, Saudi Arabia
| | - Afrah Fathi Mohammed
- Department of Surgery, Section of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Samaher M. Jbril
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marya Bahashwan
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Louai Mukharesh
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muneera Al Khashan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Chatterjee US, Basu AK, Mitra D. Insight into Posterior Urethral Valve from Our Experience: Paradigm Appended to Abate Renal Failure. J Indian Assoc Pediatr Surg 2020; 25:297-305. [PMID: 33343111 PMCID: PMC7731998 DOI: 10.4103/jiaps.jiaps_136_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of the study was to share our experience of management of posterior urethral valve (PUV) and to suggest a paradigm to impede upstaging of chronic kidney disease (CKD) and prevent end-stage renal failure (ESRF). Patients and Methods: We have treated 332 patient of PUV from March 2005 to April 2016, Of which 272 case records had adequate data to be analyzed. The mean age was 2.48 years (range: 1 day–18 years). We did primary fulguration in 231 patients, of which five patients needed bilateral ureterostomy for obstinate high creatinine level. The remaining 36 patients had primary fulguration done elsewhere. Results: The mean duration of follow-up was 7.8 years (range 3–14 years). In the end of this study, 10 patients had down staging in CKD, 36 patients had up staging in CKD, and 9 patients ended in ESRF (3.8%). Conclusions: Detection of deterioration of renal function with creatinine clearance along with identifying the causes of deterioration and necessary interventions would help to arrest upstaging of CKD otherwise that might end in ESRF. From this study and reviewing the literature, we presume that the rhabdosphincter spasm underneath actually renders bladder outlet obstruction, and cusps of PUV, particularly in neonates, amplify the obstruction, following that bladder outlet obstruction cascades detrusor hypertrophy, bladder neck hypertrophy/obstructions, and ureterovesical junction obstruction/reflux, causing gradual damage to the bladder and upper tract and deterioration of renal function as a consequence.
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Affiliation(s)
- Uday Sankar Chatterjee
- Department of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
| | - Ashoke Kumar Basu
- Department of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
| | - Debashis Mitra
- Department of Pediatric Surgery, Park Medical Research and Welfare Society, Kolkata, West Bengal, India
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Morizawa Y, Aoki K, Hori S, Gotoh D, Miyake M, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. <p>Is Endoscopic Transurethral Incision Really Effective for Boys with Refractory Daytime Incontinence?</p>. Res Rep Urol 2020; 12:273-277. [PMID: 32766174 PMCID: PMC7381088 DOI: 10.2147/rru.s254159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the clinical efficacy of endoscopic transurethral incision (TUI) for boys with refractory daytime incontinence due to a posterior urethral valve with or without nocturnal enuresis. Patients and Methods A total of 20 boys with daytime incontinence were assessed. Twelve boys underwent TUI (TUI+ group) and eight boys continued receiving oral drugs (TUI- group). The primary endpoint was the cure rate associated with TUI or NE in both groups. Results Only two boys achieved daytime continence 6 months after TUI, but no boys were cured of nocturnal enuresis 6 months after TUI. The median time to daytime continence was significantly longer in the TUI+ than in the TUI- group (52 vs 27 months, respectively; log rank P = 0.041) and the median time to dry nights was significantly longer in the TUI+ than in the TUI- group (56 vs 36 months, respectively; log rank P = 0.021). Conclusion TUI might be not effective in boys with refractory daytime incontinence.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Correspondence: Kiyohide Fujimoto Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara634-8522, JapanTel +81-744-22-3051Fax +81-744-22-9282 Email
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Haid B, Thüminger J, Lusuardi L, de Jong TPVM, Oswald J. Is there a need for endoscopic evaluation in symptomatic boys with an unsuspicious urethra on VCUG? A consideration of secondary radiologic signs of posterior urethral valves. World J Urol 2020; 39:271-279. [PMID: 32232556 DOI: 10.1007/s00345-020-03175-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A significant proportion of PUV becomes symptomatic after the perinatal period. Voiding cystourethrography (VCUG) often fails to identify PUVs. This study evaluates the relationship between the radiological appearance of the posterior urethra, potential secondary radiological signs and endoscopically documented PUV in boys with febrile UTIs, VUR, refractory symptoms of bladder overactivity or suggestive sonography findings. PATIENTS AND METHODS Data on VCUG findings and endoscopy from 92 boys (mean age 27 months) who underwent endoscopic PUV incision between 2012 and 2017 following a VCUG were reviewed. 24 boys with endoscopically unsuspicious urethras were included as control group (mean age 27.5 months). Statistical analysis was performed using Fisher's exact test. RESULTS In patients with PUV, the urethra was suspicious on a preoperative VCUG in 45.7%, whereas it appeared normal in 54.3%. Abortive forms of PUV were more frequently found in patients with a radiologically unsuspicious urethra (30%vs.16.7%, p = 0.15). Bladder neck hypertrophy on VCUG (16.7%vs.60.9%, OR 7.5, p < 0.001), a trabeculated bladder on VCUG (72%vs.37.5%, OR 4.3, p < 0.001) and a hypertrophied musculus interuretericus (38%vs.4.2%, OR 11.7, p < 0.001) were more common in patients with PUV and urethras appearing normal on VCUG as compared to controls. CONCLUSION Unsuspicious findings of the urethra on VCUG cannot exclude a relevant PUV and implicate a risk of disregarding abortive forms. The presence of secondary radiologic signs of infravesical obstruction on a VCUG despite an unsuspicious posterior urethra in boys with recurrent UTI's as well as refractory symptoms of bladder overactivity or suggestive signs on sonography must be further clarified endoscopically.
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Affiliation(s)
- Bernhard Haid
- Department for Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria. .,Department of Urology, Ludwig Maximilians University, Munich, Germany.
| | - Jonas Thüminger
- Department for Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Tom P V M de Jong
- Department of Pediatric Urology, University Children's Hospitals UMC Utrecht and Amsterdam UMC, Amsterdam, The Netherlands
| | - Josef Oswald
- Department for Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria
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Clinical Profile and Outcome of Children with Congenital Obstructive Uropathy. Indian J Pediatr 2019; 86:354-359. [PMID: 30796705 DOI: 10.1007/s12098-019-02876-w] [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: 04/14/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To study the etiology and clinical profile of congenital obstructive uropathy in children, renal status and growth at diagnosis and at follow-up and to determine the predictors for development of chronic kidney disease (CKD). METHODS An observational (retrospective-prospective) study was conducted at a tertiary care hospital in South India from September 2014 through September 2016. Sixty children diagnosed to have congenital obstructive uropathy with a minimum follow-up period of 5 y were included and followed up prospectively for 2 more years during the study period. The data of the children at admission and follow-up was obtained from the medical records and analyzed. RESULTS Congenital uretero-pelvic junction obstruction followed by Posterior urethral valve were the most common etiologies identified. Male preponderance (88.3%) was observed with poor urinary stream being the most common presentation (36.6%). Forty percent of the population had elevated creatinine. Fifteen percent were hypertensive and 25% had growth failure at diagnosis. However, there was a reduction in the number of children with poor estimated glomerular filtration rate (eGFR), hypertension and growth faltering during follow-up. Among the risk factors, hypertension at diagnosis [O.R-12.8 (2.21-74.22) and p value <0.05] and frequent urinary tract infection (UTI) [O.R-14.06 (2.32-85.42) and p value <0.05] were the most important factors for CKD progression. Children with low eGFR (< 60 ml/min/1.73m2) had more height faltering and hypertension at follow-up (p value <0.05). CONCLUSIONS Hypertension and frequent UTI were observed to be strongly associated with progression of CKD. Estimated GFR was found to be significantly associated with faltering of height and hypertension. Preserving the renal function prevents growth faltering and development of hypertension at follow-up thereby ensuring a better quality of life.
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Abdovic S, Cuk M, Cekada N, Milosevic M, Geljic A, Fusic S, Bastic M, Bahtijarevic Z. Predicting posterior urethral obstruction in boys with lower urinary tract symptoms using deep artificial neural network. World J Urol 2018; 37:1973-1979. [DOI: 10.1007/s00345-018-2588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
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Frazier SB, Katz S, Wood JB, Cassat JE. An Unusual Source of Sepsis in Two Previously Healthy Children. Clin Pediatr (Phila) 2018; 57:1120-1122. [PMID: 29084446 PMCID: PMC5878989 DOI: 10.1177/0009922817738349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Sophie Katz
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - James B. Wood
- Vanderbilt University Medical Center, Nashville, TN, USA
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Long-term renal outcome in infants with congenital lower urinary tract obstruction. Prog Urol 2018; 28:596-602. [PMID: 29980359 DOI: 10.1016/j.purol.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. PATIENTS AND METHOD We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. RESULTS 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. CONCLUSION A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. LEVEL OF INCIDENCE 4.
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Keays MA, Mcalpine K, Welk B. All grown up: A transitional care perspective on the patient with posterior urethral valves. Can Urol Assoc J 2018; 12:S10-S14. [PMID: 29681268 DOI: 10.5489/cuaj.5228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Melise A Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON
| | - Kristen Mcalpine
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON
| | - Blayne Welk
- Division of Urology, University of Western Ontario, London, ON; Canada
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14
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Haid B, Tekgül S. Primary and Secondary Enuresis: Pathophysiology, Diagnosis, and Treatment. Eur Urol Focus 2017; 3:198-206. [DOI: 10.1016/j.euf.2017.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 01/21/2023]
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15
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The changes of urethral morphology recognized in voiding cystourethrography after endoscopic transurethral incision for posterior urethral valve in boys with intractable daytime urinary incontinence and nocturnal enuresis. World J Urol 2017; 35:1611-1616. [PMID: 28247065 DOI: 10.1007/s00345-017-2018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/01/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Endoscopic transurethral incision (TUI) of posterior urethral valve (PUV) can improve daytime urinary incontinence (DUI) and nocturnal enuresis (NE). However, the underlying mechanism has not been elucidated. In this study, we retrospectively examined the mobility of the urethra before and after TUI by measuring the urethral angle with voiding cystourethrography (VCUG), to clarify the effects of TUI on the morphology of the urethra during voiding. METHODS Between July 2010 and December 2014, 29 boys with intractable DUI and/or NE were diagnosed as PUV and underwent endoscopic TUI. VCUG during voiding phase was performed at sequential radiographic spot images (1 image per second) at a 45° angle in oblique standing position. The point at which the angle of the urethra was the smallest during urination was regarded as the minimum urethral angle. The maximum urethral angle during early voiding phase was compared with the minimum urethral angle, and the percentage by which this angle changed was calculated as the flexion rate. Then changes in minimum urethral angle and flexion rate were analyzed before and 3-4 months after TUI. RESULTS After TUI, the minimum urethral angle on VCUG became more obtuse (before vs. after TUI, respectively: 112.7 vs. 124.5°, p < 0.001), the flexion rate decreased (before vs. after TUI, respectively: 11.8 vs. 4.1%, p < 0.001). CONCLUSIONS This study demonstrated a significant difference in the degree of change. The findings may contribute to understanding of the mechanism of improvement in symptoms after TUI in patients with PUV.
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Point-of-Care Ultrasound to Assess Anuria in Children. Pediatr Emerg Care 2016; 32:544-8. [PMID: 27490729 DOI: 10.1097/pec.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anuria in children may arise from a host of causes and is a frequent concern in the emergency department. This review focuses on differentiating common causes of obstructive and nonobstructive anuria and the role of point-of-care ultrasound in this evaluation. We discuss some indications and basic techniques for bedside ultrasound imaging of the urinary system.
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Zornoza M, Angulo JM, Parente A, Simal S, Burgos L, Ortiz R. Late diagnosis of posterior urethral valves. Actas Urol Esp 2015; 39:646-50. [PMID: 26112258 DOI: 10.1016/j.acuro.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 05/17/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
CLINICAL PROBLEM We diagnosed 8 patients with late-stage posterior urethral valves (PUV) between 1 and 14 years of age. Five patients complained of symptoms related to voiding dysfunction. The other 3 patients required urethrocystoscopy for other reasons (hypospadias fistulae, difficulty with catheterisation and high-grade vesicoureteral reflux [VUR]). A second review of the first 2 patients' medical history showed voiding dysfunction symptoms. All patients underwent preoperative ultrasonography: 3 patients had normal results and 5 had renal or vesical disorders. The diagnosis was reached through voiding cystourethrogram (VCUG), and 4 patients underwent urodynamic studies. The diagnosis was confirmed by urethrocystoscopy, performing valve electrofulguration. We performed urethrocystoscopy during the check-ups at 3-6 weeks and observed no stenosis. The symptoms disappeared for all patients after 20 months of follow-up. The patient with VUR was cured. The ultrasounds showed no progression of the renal involvement and showed improvement in the vesical involvement. The velocimetries during check-ups presented curves within normal ranges. DISCUSSION Most children with PUV are diagnosed through ultrasound during the neonatal period. Some patients present PUV at later ages with diverse symptoms, which impedes its diagnosis. We should suspect PUV in male patients with symptoms of voiding dysfunction, either when they have normal or pathological results from ultrasounds or VCUG. We recommend performing urethrocystoscopy to rule out urethral obstruction.
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Affiliation(s)
- M Zornoza
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España.
| | - J M Angulo
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España
| | - A Parente
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España
| | - S Simal
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España
| | - L Burgos
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España
| | - R Ortiz
- Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España
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Obstructive uropathy presenting as primary enuresis – A case report. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Matoka DJ, Marks AJ, Stoltz RS, Maizels M. Utilization of computer enhanced visual learning (CEVL) method improves endoscopic diagnosis of posterior urethral valves (PUV). J Pediatr Urol 2013; 9:498-502. [PMID: 22981142 DOI: 10.1016/j.jpurol.2012.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 07/26/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Training in urology relies largely on the traditional methods of clinical immersion and the use of reference texts. Computer enhanced visual learning (CEVL) is an on-line learning tool that may effectively supplement these methods. We evaluate the role of CEVL in establishing the endoscopic diagnosis of posterior urethral valves (PUV). MATERIAL AND METHODS This study compares test scores of PUV diagnosis made by pediatric urologists and fellows in pediatric urology training programs while watching pediatric cystourethroscopy videos before and after viewing the CEVL learning module. The CEVL module used illustrations and video clips to highlight criteria important in diagnosing PUV. Data was analyzed for improvement in test scores (Chi square). RESULTS There were 112 study subjects enrolled. An improvement in the post-test scores was observed (p < 0.001). When independently analyzing cases with PUV, an improvement in diagnosis was also observed (p < 0.005). While a trend toward improvement was observed in correctly diagnosing normal urethras, this was not statistically significant. CONCLUSION Overall, there was an improvement observed after viewing the CEVL module. This was most notable in cases where PUV was present. The CEVL module is an effective supplement for enhancing the endoscopic diagnosis of PUV.
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Affiliation(s)
- Derek J Matoka
- Loyola University Medical Center, Maywood, IL 60153, USA.
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Abbo O, Bouali O, Ballouhey Q, Mouttalib S, Lemandat A, Decramer S, Moscovici J, Galinier P. [Is there an outcome difference between posterior urethral valves diagnosed prenatally and postnatally at the time of antenatal screening?]. Prog Urol 2013; 23:144-9. [PMID: 23352308 DOI: 10.1016/j.purol.2012.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 07/17/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Posterior urethral valves (PUV) diagnosed during childhood have classically been associated with a better outcome than antenatally diagnosed PUV. The aim of our study was to compare long-term outcome of these two patients' groups. MATERIAL AND METHODS We retrospectively reviewed the medical records of boys with PUV managed between 1990 and 2010. Patient demographics, clinical background, radiographic data (including prenatal ultrasonography data when available), renal and bladder functional outcomes, surgical procedures and urinary tract infections (UTI) were abstracted. Impaired renal function (IRF) was defined as glomerular filtration rate less than 90 mL/min/1.73 m(2) at last follow-up. RESULTS We identified 69 patients with confirmed PUV. Thirty-eight were diagnosed prenatally (group 1) at 30.5 weeks of gestation and 31 had a delayed diagnosis (group 2) at a median age of 6.31 years. At diagnosis, 20 patients in group 1 had renal insufficiency versus two in group 2 (P<0.05). At the end of mean follow-up of 7.2 ± 0.5 years, in group 1, 26.3% developed IRF versus 6.3% in group 2 (mean follow-up 2.3 years). Mean age at last follow-up was 7.3 years in group 1 versus 8.3 in group 2 (P>0.05). In group 1, 27% had voiding dysfunction versus 30% in group 2 (NS). In group 1, 35% had UTI during follow-up versus 10% (P=0.01). CONCLUSION During the follow-up, the patients with delayed diagnosis VUP have developed fewer complications related to the initial obstruction than the population who was detected antenatally and managed from the early hours of life. However, the rate of IRF and voiding disorders in our study, associated with the data of the literature, highlights the potential persistence and worsening of these conditions. That is why, whatever the age at diagnosis, VUP patients require a close monitoring.
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Affiliation(s)
- O Abbo
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, CHU de Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France.
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Posterior urethral valve: delayed presentation in adolescence. Int Neurourol J 2012; 16:149-52. [PMID: 23094222 PMCID: PMC3469835 DOI: 10.5213/inj.2012.16.3.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/16/2012] [Indexed: 11/22/2022] Open
Abstract
Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in a late adolescent who first presented with preserved renal function and urinary incontinence. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases.
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Outcome of late presentation of posterior urethral valves in a resource-limited economy: challenges in management. Int J Nephrol 2012; 2012:345298. [PMID: 23050150 PMCID: PMC3459254 DOI: 10.1155/2012/345298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 08/23/2012] [Indexed: 11/17/2022] Open
Abstract
Delayed presentation of patients with posterior urethral valve with complications like severe urosepsis, uremia, and anemia are seen in our setting. Renal replacement therapy which should have been offered to these patients is not readily available for children in our country. The aim of this study is to determine the pattern of late presentation and outcome of management of posterior urethral valve in a resource-limited setting. A descriptive retrospective study (1997–2009) was conducted. Data including pattern of presentation, duration of symptoms, complications, and outcome of initial management were analyzed. Twenty-one patients were seen. The median age was 3 years (2 days–13 years). The mean duration of symptoms before presentation was 2.6 years. Nineteen patients (91%) presented with urosepsis while 8 patients (36%) presented with significant renal insufficiency. Laboratory findings varied from-mild-to marked elevation in serum creatinine. Radiological findings confirmed the diagnosis of posterior urethral valve. We concluded that late presentation is common in our setting. This is associated with high morbidity and mortality rates. Efforts at improving awareness and early diagnosis among the health team should be made to stem the tide.
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Risk factors associated with chronic kidney disease in patients with posterior urethral valves without prenatal hydronephrosis. J Urol 2011; 185:2502-6. [PMID: 21527193 DOI: 10.1016/j.juro.2011.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE Postnatal diagnosis of posterior urethral valves continues despite the prevalence of prenatal ultrasound. We identified risk factors associated with chronic kidney disease in these children. MATERIALS AND METHODS We retrospectively reviewed the medical records of boys with posterior urethral valves with clinical presentations other than prenatal hydronephrosis. We recorded presenting symptoms, age at presentation, and preoperative hydronephrosis and/or vesicoureteral reflux. Chronic kidney disease was defined as previous renal transplantation, dialysis dependence or glomerular filtration rate less than 60 ml per minute/1.73 m(2) at last followup. We used univariate survival analysis with the log rank test of equality for categorical variables and Cox proportional hazard regression for continuous variables to identify risk factors associated with progression to chronic kidney disease. RESULTS We identified 141 boys with posterior urethral valves with a postnatal presentation. Median age at presentation was 46 months (range 0.3 to 174). Febrile urinary tract infection in 28% of patients and voiding complaints in 50% were the most common presentations. A total of 12 patients (9%) progressed to chronic kidney disease up to 23 years after initial presentation. Preoperative bilateral hydronephrosis, increased hydronephrosis severity and bilateral vesicoureteral reflux were associated with progression to chronic kidney disease. CONCLUSIONS Approximately 10% of cases with postnatal presentation of posterior urethral valves progress to chronic kidney disease, sometimes decades after the initial presentations. Although all patients with posterior urethral valves should be counseled on the potential loss of renal function, children with risk factors warrant close followup into adulthood.
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Kanaroglou N, Braga LH, Massaro P, Lau K, Demaria J. Lower abdominal mass in a 16-year old adolescent: an unusual presentation of posterior urethral valves. Can Urol Assoc J 2011; 5:E1-3. [PMID: 21470520 DOI: 10.5489/cuaj.10045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in an adolescent who first presented with renal failure and a palpable lower abdominal mass due to urinary retention. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases.
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Affiliation(s)
- Niki Kanaroglou
- Division of Urology, McMaster Children's Hospital, Hamilton, ON
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25
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Agrawal S, Parakh A, Agrawalla A. Cleft palate, arachnoid cyst and posterior urethral valve. BMJ Case Rep 2010; 2010:2010/sep10_1/bcr0420102873. [PMID: 22778242 DOI: 10.1136/bcr.04.2010.2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 5-month-old infant presented with cleft palate, febrile urinary tract infection and abnormal movements. His urinary stream was poor and investigations revealed posterior urethral valve and grade V vesicoureteric reflux. This baby was investigated for seizure activity and on MRI of the brain was found to have a large arachnoid cyst, splaying the occipital horns and compressing the posterior aspect of third ventricle leading to dilatation of the ventricles. This seems to be a very unusual coexistence of three abnormalities in one patient for which no plausible explanation can be given. It appears to be a chance finding.
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Affiliation(s)
- Sanwar Agrawal
- Department of Pediatrics, Ekta Institute of Child Health, Raipur, India.
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Acharya H, Dhende NP, Mane SB, Obaidah A. Posterior urethral valves with vesical calculus: A rare association. J Indian Assoc Pediatr Surg 2010; 14:115-6. [PMID: 20376254 PMCID: PMC2847137 DOI: 10.4103/0971-9261.57705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Posterior urethral valve and vesical calculus are individually among the most common causes of obstructive lower urinary complaints in children. There are very few reports of association between posterior urethral valves and bladder calculus. We report three such cases. This association of the vesical calculi with posterior urethral valves may lead to a delay in the diagnosis of the posterior urethral valves. The diagnosis of posterior urethral valves should be suspected in all children with vesical or urethral calculi who have persistence of symptoms even after removal of the calculi.
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Affiliation(s)
- Himanshu Acharya
- Department of Paediatric Surgery, SIR J J Group of Hospitals, Mumbai, India
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Posterior Urethral Valves: Search for a Diagnostic Reference Standard. Urology 2008; 72:1022-5. [DOI: 10.1016/j.urology.2008.04.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 12/05/2007] [Accepted: 04/24/2008] [Indexed: 11/17/2022]
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Jesus CMND, Trindade Filho JCDS, Goldberg J. Late presentation of posterior urethral valve: two case reports. SAO PAULO MED J 2008; 126:126-7. [PMID: 18553037 PMCID: PMC11026017 DOI: 10.1590/s1516-31802008000200012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 11/29/2006] [Accepted: 03/03/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Posterior urethral valve (PUV) is a widely known condition affecting males that generally presents prenatally or at birth. PUVs have also been occasionally described in literature in cases diagnosed during adolescence or adulthood. CASE REPORT This report presents two late PUV cases, one in a teenager and the other in an adult. Both cases had had clinical signs of urinary tract infection and obstructive urinary symptoms. The diagnoses were made by means of voiding cystourethrography and urethrocystoscopy. Endoscopic valve fulguration was the treatment chosen for both. Their follow-up was uneventful.
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Ansari MS, Singh P, Mandhani A, Dubey D, Srivastava A, Kapoor R, Kumar A. Delayed Presentation in Posterior Urethral Valve: Long-Term Implications and Outcome. Urology 2008; 71:230-4. [PMID: 18308090 DOI: 10.1016/j.urology.2007.09.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 07/31/2007] [Accepted: 09/19/2007] [Indexed: 11/16/2022]
Affiliation(s)
- M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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Ziylan O, Oktar T, Ander H, Korgali E, Rodoplu H, Kocak T. The Impact of Late Presentation of Posterior Urethral Valves on Bladder and Renal Function. J Urol 2006; 175:1894-7; discussion 1897. [PMID: 16600793 DOI: 10.1016/s0022-5347(05)00933-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE We retrospectively reviewed the records of patients with late presentation of PUVs, and compared bladder and renal function to that in patients with an early diagnosis of PUVs. MATERIALS AND METHODS We retrospectively reviewed the charts of 36 males (mean age at diagnosis 8.8 years, range 5 to 14) with late presentation of PUVs who were treated at our institution between 1986 and 2004. Of these patients 20 had undergone urodynamic evaluation during followup (mean age 10.65 years, range 5 to 23). We chose as controls 19 age matched children with PUVs who were diagnosed and treated before age 5 years and underwent urodynamic evaluation during followup (mean age at urodynamic evaluation 8.52 years, range 6 to 15). Urodynamic parameters were compared between the 2 patient groups. Renal function in the late presenting cases was also compared to controls. RESULTS The most common symptoms at presentation were diurnal enuresis (17 patients, 47.2%) poor stream (7, 19.4%) and urinary retention (5, 13.9%). Overall, urodynamic bladder abnormalities were detected in 17 of 20 patients (85%), detrusor overactivity in 3 (15%), significant post-void residual in 9 (45%) and bladder capacity greater than expected for age in 9 (45%). No significant difference in bladder capacity, compliance or post-void residual was demonstrated between the late presenting and control groups. Only detrusor overactivity was significantly lower in the late presenting group (p = 0.013). After a mean followup of 67.03 months age specific creatinine levels were increased in 13 of 27 patients (48.1%), including 7 (25.9%) with ESRD. Renal function was significantly impaired in the late presenting group compared to controls (48.1% vs 13.7%, p = 0.001). CONCLUSIONS We found a significantly lower rate of detrusor overactivity (15%) in patients with late presenting PUVs. Comparison of urodynamic parameters between the early and late presenting groups did not reveal any significant difference. This similar pattern of bladder dysfunction, independent of age at relief of obstruction, may indicate a common pathophysiological etiology for bladder dysfunction in all patients with PUVs. Also, renal function was significantly impaired in the late presenting group in this series.
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Affiliation(s)
- Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, Medical Faculty of Istanbul, University of Istanbul, Istanbul, Turkey.
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de Kort LMO, Uiterwaal CSPM, Beek EJA, Jan Nievelstein RA, Klijn AJ, de Jong TPVM. Reliability of voiding cystourethrography to detect urethral obstruction in boys. Urology 2004; 63:967-71; discussion 971-2. [PMID: 15134990 DOI: 10.1016/j.urology.2003.11.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Accepted: 11/14/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the reliability of voiding cystourethrography (VCUG) to diagnose infravesical obstruction in boys. METHODS Hard copies of the VCUG findings of 72 boys were assessed by two pediatric radiologists and two pediatric urologists. The investigators were instructed to consider six items related to infravesical obstruction: vesicoureteral reflux, bladder wall thickness, bladder diverticulum, abnormal prostatic urethra, visible urethral obstruction, and obstruction in the sphincter area. Also, a scoring system was developed using these six items. Agreement among the four investigators for evaluation of the items on VCUG and for the scoring system was assessed using the kappa statistic. All boys underwent urethrocystoscopy, and the endoscopic findings were compared with VCUG results. Odds ratios were calculated for the results of VCUG for each investigator to predict the chance of cystoscopic infravesical obstruction. RESULTS Agreement among observers for vesicoureteral reflux and bladder diverticulum was good (kappa values for paired observers of 0.82 and 0.79). Agreement for bladder wall thickness, abnormal prostatic urethra, visible urethral obstruction, obstruction in the sphincter area, and the scoring system was poor (kappa values of 0.08, 0.35, 0.33, 0.26, and 0.33, respectively). Consequently, the results of VCUG could not predict for endoscopic infravesical obstruction accurately, although substantial differences occurred among investigators. Items on which investigators reached good agreement were negatively related to the risk of having infravesical obstruction. CONCLUSIONS Because agreement among investigators in the assessment of most items on VCUG was poor and because for the items with good agreement, the predictive power was poor, the current clinical use of VCUG for diagnosing infravesical obstruction needs reevaluation.
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Affiliation(s)
- Laetitia M O de Kort
- Department of Pediatric Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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El-Sherbiny MT, Hafez AT, Shokeir AA. Posterior urethral valves: does young age at diagnosis correlate with poor renal function? Urology 2002; 60:335-8; discussion 338. [PMID: 12137837 DOI: 10.1016/s0090-4295(02)01821-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine whether young age at presentation is associated with poor renal function in patients with posterior urethral valves (PUVs). Previous studies have indicated that a young age at diagnosis is an adverse prognostic factor for patients with PUVs. METHODS Fifty-three children with PUVs were diagnosed between January 1998 and March 2000. The patients included 25 infants with a median age of 3 months (group 1) and 28 children with a median age of 3.5 years (group 2). No statistically significant difference was present between the two groups regarding presenting symptoms, incidence of hydronephrosis, bilateral vesicoureteral reflux, presence of popoff mechanisms, or number of positive urinary cultures at presentation. Primary valve ablation was carried out in all patients. The median follow-up period for groups 1 and 2 was 19 and 18.5 months, respectively (P <0.05). RESULTS The percentage of serum creatinine deviation greater than the normal age-reference range was calculated for each patient at diagnosis and at the last follow-up visit. The median percentage of serum creatinine deviation at presentation was 190% for group 1 and 22% for group 2 (P >0.05). The median percentage of serum creatinine deviation at the last follow-up visit was nil for group 1 and 10% for group 2 (P <0.009). Persistently dilated upper tracts were noted in 48% and 86% of patients in groups 1 and 2, respectively (P <0.004). CONCLUSIONS In contrast to the findings of previous studies, we provide evidence of a less favorable outcome with delayed presentation of PUVs relative to those diagnosed in the first year after birth in respect to renal function and upper tract dilation.
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Affiliation(s)
- M T El-Sherbiny
- Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
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Duncombe GJ, Barker AP, Moss TJM, Gurrin LC, Charles AK, Smith NM, Newnham JP. The effects of overcoming experimental bladder outflow obstruction in fetal sheep. J Matern Fetal Neonatal Med 2002; 11:130-7. [PMID: 12375543 DOI: 10.1080/jmf.11.2.130.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To develop an ovine model of fetal bladder outflow obstruction and to investigate the effect on the kidney of surgical relief of the obstruction in the prenatal period. METHODS Ultrasound examination and amniocentesis were performed on 68 date-bred pregnant ewes at day 57 of pregnancy (term = 150 days). Fetal gender was determined using a molecular technique to identify single male fetuses. The urethra and urachus were ligated at hysterotomy on 20 of these fetuses at 75 days' gestation. Comparisons were made with six controls that did not undergo operation. Changes that occurred in fetal urinary tract appearance were detected using serial ultrasound examinations. Seven obstructed cases chosen at random had further prenatal surgery on day 94 to decompress the obstructed urinary tract by vesicostomy. The animals were killed at 110 days' gestation and post-mortem studies were performed. RESULTS Fourteen days after surgical obstruction, there were increases in the summed renal lengths (33 mm vs. 28 mm, p = 0.003) and renal pelvis anteroposterior (A-P) diameters (8 mm vs. 5.5 mm, p = 0.02). In the group allocated to receive surgical decompression, 9 days' relief of obstruction resulted in significant reductions in summed renal lengths (30 mm vs. 41 mm, p = 0.024; controls 31 mm) and renal pelvis A-P diameters (5.8 mm vs. 8.9 mm, p = 0.012; controls < 2 mm). Postmortem histological examination in the surgical decompression group revealed an estimated number of glomeruli similar to controls and greater than in the obstructed cases. CONCLUSION Surgical relief of fetal bladder outflow obstruction in ovine mid-pregnancy results in improved renal appearance on ultrasonic and histopathological examinations.
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Affiliation(s)
- G J Duncombe
- Women and Infants Research Foundation, Subiaco, Western Australia
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Abstract
Posterior urethral valves are a common problem encountered by pediatric urologists. The diagnosis is most frequently suggested by antenatal screening ultrasound. A variety of pre- and postnatal parameters have been identified to aid in predicting ultimate renal outcome. These prognostic tools are invaluable to the clinician for counseling parents and for choosing appropriate management. Several approaches to the treatment of patients with posterior urethral valves exist, and the ideal strategy is debatable. As technology evolves, more options for early intervention become available. Whether early detection and antenatal intervention improve patient outcome remains to be proven.
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Affiliation(s)
- J M Gatti
- Division of Urology, University of Kansas School of Medicine and Children's Mercy Hospital, 5520 College Boulevard, Suite 425, Overland Park, KS 66211, USA.
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Reply by the authors. Urology 2000; 56:657. [PMID: 11018626 DOI: 10.1016/s0090-4295(00)00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Editorial comment. Urology 2000. [DOI: 10.1016/s0090-4295(00)00785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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