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Original Research - Special Collection: Paediatric Radiology
Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children?
Submitted: 22 October 2019 | Published: 09 June 2020
About the author(s)
Zakiyah Gaibie, Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; Department of Urology, Helen Joseph Hospital, Johannesburg; Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South AfricaNasreen Mahomed, Department of Radiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Karen L. Petersen, Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; Department of Paediatric Nephrology, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
Glenda Moonsamy, Division of Paediatric Nephrology, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; Department of Paediatric Nephrology, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
Aakram A.H. Bokhari, Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; Department of Urology, Helen Joseph Hospital, Johannesburg; Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg; Department of Urology, College of Medicine, Hail University, Hail; Department of Urology, King Fahad General Hospital, Jeddah, South Africa
Ahmed Adam, Division of Urology, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg; Department of Urology, Helen Joseph Hospital, Johannesburg; Department of Paediatric Urology, Rahima Moose Mother and Child Hospital, Johannesburg, South Africa
Abstract
Background: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful.
Objectives: We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation.
Methods: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies.
Results: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 (p = 0.001), 2.5–3 and 3.5.
Conclusion: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.
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Crossref Citations
1. Computational fluid dynamics modeling approaches to assess lower urinary tract hydraulic dynamics in posterior urethral valve before and after endoscopic valve ablation: a pilot study
Hong-Song Chen, Xing Liu, Zhi-Cheng Zhang, Zi-Han Ye, Tao Lin, Da-Wei He, Guang-Hui Wei
World Journal of Urology vol: 40 issue: 2 first page: 505 year: 2022
doi: 10.1007/s00345-021-03875-3