Shi Shengkun,Liu Xing,Yin Xiaoming,et al.Combined analysis of clinical symptoms,urodynamics,and imaging features for identifying atypical posterior urethral valves in children[J].Journal of Clinical Pediatric Surgery,,():621-626.[doi:10.3760/cma.j.cn101785-20260331-00148]
Combined analysis of clinical symptoms,urodynamics,and imaging features for identifying atypical posterior urethral valves in children
- Keywords:
- Posterior Urethral Valves; Lower Urinary Tract Obstruction; Overactive Bladder; Voiding Cystourethrography; Diagnostic Model
- Abstract:
- Objective Posterior urethral valves (PUV) represent a primary cause of lower urinary tract obstruction in boys.Approximately 50% of cases,particularly atypical valves located at the 12 o’clock position,are missed on voiding cystourethrography (VCUG).Early identification is critical for preventing renal failure.This study preliminarily explores a diagnostic model for atypical PUV based upon imaging and urodynamic parameters,providing data support for optimizing the screening workflow for atypical PUV. Methods This study retrospectively enrolled 62 male pediatric patients with suspected posterior urethral valves (PUV) at Shengjing Hospital of China Medical University from 2011 to 2025.All patients underwent cystoscopy and were divided into two groups: a non-valve group (n=22) and an atypical valve group (VCUG-negative,cystoscopy-positive,n=40).General medical history,imaging,and urodynamic data were collected for both groups.Univariate analysis was performed to compare intergroup differences,and multivariate logistic regression with bidirectional stepwise selection was used to identify independent predictive factors and construct a diagnostic model.The model’s discriminative performance,calibration,and clinical utility were assessed using receiver operating characteristic (ROC) curves,calibration curves,and decision curve analysis (DCA).Results Univariate analysis showed that compared with the atypical valve group,the non valve group had a lower incidence of overactive bladder (OAD) (4.55% vs.32.50%),a lower urethral flexion rate (8±3 vs.16±6),a higher aspect ratio of posterior urethral dilation (2.81 (2.23,3.38) vs.1.88 (1.36,2.23)),and a lower incidence of PUV indirect signs (ureteral muscle hypertrophy,bladder neck hypertrophy,bladder trabeculation) (P<0.05).Multivariate logistic regression analysis determined that urethral flexion rate (OR=1.678,95%CI:1.206-2.325) and posterior urethral dilation aspect ratio (OR=0.174,95%CI:0.046-0.638) were independent predictors of atypical PUV (P<0.05).The area under the curve of the joint diagnostic model is 0.959 (95%CI:0.910~1.000),the optimal cutoff value is 0.721,the sensitivity is 95.16%,and the specificity is 86.36%.The calibration curve and DCA both confirm that the model has good consistency and strong clinical practicality(χ2=9.289,P=0.319). Conclusion A diagnostic pathway combining OAB screening via urodynamic study with measurement of urethral tortuosity index and posterior urethral dilation height-to-width ratio on VCUG can effectively identify children with atypical PUV.Cystoscopic evaluation is still recommended for suspicious individuals with negative VCUG for preventing secondary renal injury.
References:
[1] Tambo FFM,Tolefac PN,Ngowe MN,et al.Posterior urethral valves: 10 years audit of epidemiologic,diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital[J].BMC Urol,2018,18(1):46.DOI:10.1186/s12894-018-0364-1.
[2] ?zen MA,Ta?demir M,Gündo?du G,et al.Does voiding cystourethrogram exclude posterior urethral valves in late presenting cases?[J].Eur J Pediatr Surg,2019,29(1):85-89.DOI:10.1055/s-0038-1672146.
[3] Ekarat P,Attawettayanon W,Limratchapong C,et al.Posterior urethral valve in Thai boys[J].BMC Pediatr,2023,23(1):445.DOI:10.1186/s12887-023-04281-x.
[4] 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[J].World J Urol,2021,39(1):271-279.DOI:10.1007/s00345-020-03175-2.
[5] Nakai H,Hyuga T,Kawai S,et al.Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children[J].Investig Clin Urol,2017,58(S1):S46-S53.DOI:10.4111/icu.2017.58.S1.S46.
[6] Lim CS,Abrams P.The Abrams-Griffiths nomogram[J].World J Urol,1995,13(1):34-39.DOI:10.1007/BF00182664.
[7] Rosier PFWM,Schaefer W,Lose G,et al.International continence society good urodynamic practices and terms 2016: urodynamics,uroflowmetry,cystometry,and pressure-flow study[J].Neurourol Urodyn,2017,36(5):1243-1260.DOI:10.1002/nau.23124.
[8] Werneburg GT,Stoffel JT.Bladder compliance: how we define it and why it is important[J].Urol Clin North Am,2024,51(2):209-220.DOI:10.1016/j.ucl.2023.12.001.
[9] Hyuga T,Nakamura S,Kawai S,et al.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[J].World J Urol,2017,35(10):1611-1616.DOI:10.1007/s00345-017-2018-4.
[10] Wu CQ,Blum ES,Patil D,et al.Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves[J].J Pediatr Urol,2022,18(6):813-819.DOI: 10.1016/j.jpurol.2022.06.002.
[11] Wagstaff B,Panabokke G,Barker A,et al.Boys with bladder dysfunction may have posterior urethral valves-A simple framework to aid investigation[J].J Pediatr Urol,2024,20(6):1057-1063.DOI:10.1016/j.jpurol.2024.09.004.
Memo
收稿日期:2026-3-31。
基金项目:国家自然科学基金(82371722); 辽宁省教育厅基本科研项目(LJKMZ20221180)
通讯作者:杨屹,Email:18940251106@163.com