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?

Zakiyah Gaibie, Nasreen Mahomed, Karen L. Petersen, Glenda Moonsamy, Aakram A.H. Bokhari, Ahmed Adam
South African Journal of Radiology | Vol 24, No 1 | a1820 | DOI: https://doi.org/10.4102/sajr.v24i1.1820 | © 2020 Zakiyah Gaibie, Nasreen Mahomed, Karen L. Petersen, Glenda Moonsamy, Akram A.H. Bokhari, Ahmed Adam | This work is licensed under CC Attribution 4.0
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 Africa
Nasreen 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


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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.


Keywords

Posterior urethral valves; Urethral ratio; Posterior anterior urethral ratio; Voiding cystourethrogram; Golden ratio

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