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Bladder height width ratio on voiding cystourethrogram as a predictor of future valve bladder in children with

Ramesh Babu1, Venkata Sai2

  • 1Pediatric Urology Unit, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India. drrameshbabu1@gmail.com.

Pediatric Surgery International
|April 14, 2022
PubMed

Insights

The bladder height width ratio (HWR) on voiding cystourethrogram can predict the development of valve bladder in children with posterior urethral valves (PUV). An HWR cutoff of 1.45 demonstrated high sensitivity and specificity in identifying patients at risk.

Area of Science:

  • Pediatric Urology
  • Radiology
  • Nephrology

Background:

  • Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
  • Prompt treatment of PUV is crucial for improving renal outcomes.
  • Valve bladder, a complication of PUV, can lead to persistent lower urinary tract dysfunction.

Purpose of the Study:

  • To investigate the predictive value of bladder height width ratio (HWR) on voiding cystourethrogram (VCUG) for the development of valve bladder in children with PUV.
  • To establish a specific HWR cutoff for predicting valve bladder.
  • To correlate HWR with urodynamic findings suggestive of valve bladder.

Main Methods:

  • Retrospective analysis of 102 patients who underwent primary PUV ablation and subsequent urodynamics.
  • Measurement of bladder height width ratio (HWR) from VCUG images.
  • Receiver operating characteristic (ROC) curve analysis to determine HWR cutoff for predicting valve bladder.
  • Correlation of HWR with urodynamic parameters such as detrusor overactivity and elevated pressures.

Main Results:

  • A bladder height width ratio (HWR) cutoff of 1.45 was identified with high accuracy (AUC 0.93) in predicting valve bladder.
  • HWR cutoff of 1.45 showed 89% sensitivity and 84% specificity for predicting future valve bladder.
  • Patients with HWR > 1.45 had significantly higher rates of detrusor overactivity (74%) compared to those with HWR < 1.45 (11%) (p=0.001).

Conclusions:

  • Bladder height width ratio (HWR) measured on VCUG is a valuable, non-invasive tool for predicting the development of valve bladder in children with PUV.
  • An HWR cutoff of 1.45 can aid in identifying patients who may benefit from closer urodynamic monitoring.
  • This parameter can assist in risk stratification and guiding management strategies for children with PUV.
Abstract

Keywords:
Height width ratioPosterior urethral valveUrodynamicsVCUGValve bladder

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