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[Bladder neck and urethral obstructions in childhood. Radiological study (review and personal case reports)]
Insights
This study reviews childhood bladder neck and urethral obstructions, highlighting radiological findings in conditions like urethral valves and ectopic ureterocele. While useful, imaging alone has diagnostic limitations, especially in differentiating mechanical from neurological causes.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Medical Science
Background:
- Childhood bladder neck and urethral obstructions are significant uropathies requiring accurate diagnosis.
- Radiological imaging plays a crucial role in identifying the causes and effects of these obstructions.
Observation:
- A review of nosological aspects and typical radiological features of obstructive uropathies in children.
- Case series included urethral valves, meatal stenosis, urethral stenosis, ectopic ureterocele, and neurogenic bladder in 11 pediatric patients (0-10 years).
- Emphasis on posterior urethral valves and ectopic ureterocele due to severe hydrodynamic effects on the urinary tract.
Findings:
- Radiological examinations, including post-surgical follow-ups, were presented for various obstructive conditions.
- Demonstrated the diagnostic challenges in differentiating mechanical obstructions from neurogenic bladder using solely radiological methods.
- Confirmed the utility and limitations of radiological examinations in diagnosing bladder neck and urethral obstructions in children.
Implications:
- Highlights the importance of comprehensive diagnostic approaches beyond imaging for pediatric lower urinary tract obstructions.
- Informs clinicians about the specific radiological signs associated with different obstructive uropathies in childhood.
- Underscores the need for careful interpretation of imaging findings, particularly in cases with suspected neurogenic bladder.
Abstract:
In the first part the authors report a nosological review of the obstructions of the bladder neck and urethra in childhood and present the most typical radiological aspects of the most important obstructive uropathies. In the second part they illustrate their cases, that include 11 patients between 0 and 10 years, of which 4 males, with urethral valves; 2 females, with external urethral meatus stenosis; 1 male, with non valvular stenosis of urethra: 2 one male and one female, with extrinsic obstruction by ectopic ureterocele; and 2 females, with neurologic bladder. The authors point out the cases with obstruction by posterior urethral valves and by ectopic ureterocele, mainly for the severe hydrodynamic effects of low obstruction on bladder, ureters and pelvis; the authors present, in some cases, also later radiological examinations, obtained after surgical removal of the obstruction. The two cases of neurological bladder are presented in order to point out the difficulty of an exclusively radiological differential diagnosis between some cases of true mechanical obstruction and obstruction caused by neuromuscular disorder of low urinary tract. At last the Authors confirm again the usefulness, but also the limits, of the radiological examination alone in diagnosis of the obstructions of bladder neck and urethra in childhood.