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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

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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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Authors and Affiliations

  1. Department for Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Seilerstätte 4, 4020, Linz, Austria

    Bernhard Haid, Jonas Thüminger & Josef Oswald

  2. Department of Urology, Ludwig Maximilians University, Munich, Germany

    Bernhard Haid

  3. Department of Urology, Paracelsus Medical University, Salzburg, Austria

    Lukas Lusuardi

  4. Department of Pediatric Urology, University Children’s Hospitals UMC Utrecht and Amsterdam UMC, Amsterdam, The Netherlands

    Tom P. V. M. de Jong

Authors
  1. Bernhard Haid
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  2. Jonas Thüminger
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  3. Lukas Lusuardi
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  4. Tom P. V. M. de Jong
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  5. Josef Oswald
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Contributions

BH: Protocol development, data collection and management, data analysis, manuscript writing. JT: data collection and analysis, manuscript writing. LL: manuscript editing. TJ: protocol development, manuscript editing. JO: protocol development, manuscript writing.

Corresponding author

Correspondence to Bernhard Haid.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study protocol of this retrospective study is in accordance with the ethical standards of the institutional research committee (Gemeinsame Ethikkommission der Barmherzigen Schwestern + Barmherzige Brüder”, EKS 38/17, approved on 2nd Nov 2017) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Compliant with the journals guidelines and as approved by the institutional ethics committee, there was no need for obtaining informed consent from the included patients/their parents. None of the published endoscopic and radiologic images contain any identifying characteristics.

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Haid, B., Thüminger, J., Lusuardi, L. et al. 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 39, 271–279 (2021). https://doi.org/10.1007/s00345-020-03175-2

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  • DOI: https://doi.org/10.1007/s00345-020-03175-2

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