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28
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CONGRESS OF THE ESPU
16:05–16:08
S11-2 (PP)
POSTERIOR URETHRAL VALVE AS A CAUSE OF LOWER
URINARY TRACT SYMPTOMS: FREQUENCY AND CLINICAL
CHARACTERISTICS
Slaven ABDOVIC
1
, Martin CUK
1
, Zeljka MUSTAPIC
1
, Snjezana FUSIC
1
,
Mirjana STANIC
1
, Mislav BASTIC
2
and Zoran BAHTIJAREVIC
2
1) Children’s Hospital Zagreb, Department of Pediatric Nephrology, Zagreb, CROATIA - 2) Children’s Hospital Zagreb,
Department of Pediatric Urology, Zagreb, CROATIA
PURPOSE
Reports of late findings of posterior urethral valve (PUV) in patients with lower urinary tract symp-
toms (LUTS) are scarce. Aim was to investigate frequency and clinical characteristics of PUV in
boys referred to outpatient clinic for LUTS.
PATIENTS AND METHODS
A retrospective, case-control study included 255 boys aged 3-18 years with storage and voiding
LUTS. Patients with acute urinary tract infection, psychomotor retardation, urogenital or rectal
surgery were excluded. Bladder diary, ultrasound, uroflowmetry, urinalysis, and urine culture were
obtained from all participants. Cystoscopy was ordered for patients with maximum flow rate persis-
tently <5
th
percentile who had symptoms refractory to the standard urotherapy.
RESULTS
Maximum flow rate <5
th
percentile was found in 38 patients (14.9%), and in 24 cases cystoscopy
was performed. In 22 patients PUV was diagnosed (Young’s type III 80%). Statistically significant
difference in median age was not found between patients with PUV (7.5 years; interquartile range
6.8-11.3 years) and without PUV (7.4 years; interquartile range 5.9-9.9 years). Patients with PUV
had significantly more often urgency (p=0.005), increased voiding frequency (p=0.036), straining
(p=0.001), weak stream/intermittency (p<0.001), and residual urine (p=0.007). Enuresis was signifi-
cantly more reported in boys without PUV (p<0.001). Statistically significant predictor variables in
favor of PUV were urgency (OR=10.59, 95% CI=1.98-56.65, p=0.006), weak stream/intermittency
(OR=6.06, 95% CI=1.34-27.41, p=0.019), and maximum flow rate <5
th
percentile (OR=100.12, 95%
CI=11.12-901.76, p<0.001). Complete response was reported for 90% of patients with PUV within
4 months after electroincision.
CONCLUSIONS
PUV was diagnosed in 8.6% of boys with LUTS and we strongly recommend to include uroflow
study in routine workup for all patients, as well as to consult urologist when maximum flow rate is
persistently <5
th
percentile, especially in cases of urgency and weak stream or intermittency.