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,2026,(07):621-626.[doi:10.3760/cma.j.cn101785-20260331-00148]
基于临床症状、尿流动力学及影像学特征识别非典型尿道瓣膜的模型初探
- Title:
- 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
- 摘要:
- 目的 初步探索基于影像学与尿流动力学指标的非典型后尿道瓣膜(posterior urethral valves,PUV)诊断模型。方法 回顾性纳入2011年1月至2025年1月中国医科大学附属盛京医院62例疑似PUV男性患儿,经膀胱镜检查分为两组:无瓣膜组(n=22)、非典型瓣膜组[排尿期膀胱尿道造影(voiding cystourethrogram,VCUG)阴性、镜检阳性,n=40]。收集两组患儿一般病史、影像学、尿流动力学资料;采用单因素分析、多因素Logistic双向逐步回归筛选独立预测因子,构建诊断模型;采用受试者操作特征(receiver operating characteristic,ROC)曲线、校准曲线、决策曲线分析(decision curve analysis,DCA)评估模型判别效能、校准度与临床实用性。结果 单因素分析显示,与非典型瓣膜组相比,无瓣膜组患儿的膀胱过度活动症(overactive bladder,OAB)发生率更低(4.55%比32.50%),尿道屈曲率更小(8±3比16±6),后尿道扩张高宽比更高[2.81(2.23,3.38)比1.88(1.36,2.23)],且PUV间接征象(输尿管间肌肥大、膀胱颈肥大、膀胱小梁化)的发生率更低(P<0.05)。多因素Logistic回归分析确定尿道屈曲率(OR=1.678,95%CI:1.206~2.325)和后尿道扩张高宽比(OR=0.174,95%CI:0.046~0.638)是非典型PUV的独立预测因子(P<0.05)。联合诊断模型的曲线下面积为0.959(95%CI:0.910~1.000),最佳截断值为0.721,灵敏度为95.16%,特异度为86.36%。校准曲线与DCA均证实模型具有良好的一致性和较强的临床实用性(χ2=9.289,P=0.319)。结论 联合尿流动力学OAB筛查、VCUG测量尿道屈曲率与后尿道扩张高宽比,可构建非典型PUV诊断路径;VCUG阴性的可疑患儿仍推荐行膀胱镜评估,以预防继发性肾损伤。
- 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.
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备注/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