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.

中文翻译：

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是否需要对 VCUG 上无可疑尿道的有症状男孩进行内镜评估？后尿道瓣膜继发影像学征象的考虑

摘要

介绍

很大一部分 PUV 在围产期后出现症状。排尿膀胱尿道造影 (VCUG) 通常无法识别 PUV。本研究评估了发热性 UTI、VUR、膀胱过度活动的难治性症状或提示性超声检查结果的男孩后尿道的放射学外观、潜在的继发性放射学体征和内窥镜记录的 PUV 之间的关系。

患者和方法

回顾了 92 名男孩（平均年龄 27 个月）在 2012 年至 2017 年期间在 VCUG 后接受内窥镜 PUV 切口的 VCUG 发现和内窥镜检查数据。24 名内镜检查无可疑尿道的男孩作为对照组（平均年龄 27.5 个月）。使用Fisher精确检验进行统计分析。

结果

在 PUV 患者中，45.7% 的术前 VCUG 尿道可疑，而 54.3% 的尿道看起来正常。流产形式的 PUV 更常见于放射学不可疑的尿道患者（30% 对 16.7%，p  = 0.15）。VCUG 上的膀胱颈肥大（16.7%vs.60.9%，OR 7.5，p  < 0.001），VCUG 上的小梁膀胱（72%vs.37.5%，OR 4.3，p  < 0.001）和肥大的输尿管间肌（38%vs） .4.2%, OR 11.7, p  < 0.001) 与对照组相比，在 VCUG 上显示正常的 PUV 和尿道患者中更为常见。

结论

VCUG 尿道的可疑发现不能排除相关的 PUV，并暗示存在忽视流产形式的风险。尽管复发性 UTI 男孩的后尿道可疑，以及膀胱过度活动的难治性症状或超声检查提示性症状，但 VCUG 上存在膀胱下梗阻的继发性放射学迹象必须通过内窥镜进一步澄清。