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Area of Science:

  • Pediatric Urology
  • Diagnostic Imaging
  • Medical Diagnostics

Background:

  • Delayed presentation of posterior urethral valves (PUVs) poses diagnostic challenges.
  • Voiding cystourethrogram (VCUG) is a common diagnostic tool, but its reliability in late-presenting PUVs is questioned.
  • Late PUVs require careful evaluation due to their rarity and potential for missed diagnosis.

Purpose of the Study:

  • To evaluate children diagnosed with late-presenting posterior urethral valves.
  • To assess the reliability of Voiding Cystourethrogram (VCUG) in diagnosing late-onset PUVs.
  • To determine the optimal diagnostic approach for late-presenting PUVs.

Main Methods:

  • Retrospective analysis of patient records diagnosed with late-presented PUVs between 2003 and 2017.
  • Evaluation of diagnostic parameters including age, symptoms, urinalysis, ultrasound, urodynamics, VCUG, and scintigraphy.
  • Assessment of postoperative follow-up conditions.

Main Results:

  • Seventeen boys with late-presented PUVs were identified (mean age 7.35 years).
  • Common symptoms included urinary frequency, incontinence, and febrile urinary infections.
  • VCUG identified PUV in 10 patients, but 6 showed normal urethras, and one was inconclusive; cystoscopy is recommended.

Conclusions:

  • Late-presenting PUVs can be missed on VCUG.
  • Cystoscopic examination is recommended for diagnosing PUVs in boys with recurrent UTIs, persistent reflux, or daytime incontinence, irrespective of VCUG findings.