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28
TH
CONGRESS OF THE ESPU
S11-10 (P without presentation)
DELAYED DIAGNOSIS OF INFRAVESICAL
OBSTRUCTION IN BOYS: THE ROLE AND VALUE
OF URETHROCYSTOSCOPY
Stanislaw WARCHOL
1
, Grazyna KRZEMIEN
2
, Agnieszka SZMIGIELSKA
2
,
Jan ZOLADEK
3
, Ewa MAKULA
3
, Przemyslaw BOMBINSKI
4
and Teresa DUDEK-WARCHOL
1
1) Medical University of Warsaw, Department of Pediatric Surgery and Urology, Warsaw, POLAND - 2) Medical
University of Warsaw, Department of Pediatrics and Nephrology, Warsaw, POLAND - 3) Medical University of Warsaw,
Student’s Society for Pediatric Surgery and Urology, Warsaw, POLAND - 4) Medical University of Warsaw, Department
of Pediatric Radiology, Warsaw, POLAND
PURPOSE
VCUG is well accepted study to detect PUV, however, there is still debate on the accuracy of
this diagnostic procedure. Recently published results of systematic review showed that to date,
firm evidence to support common diagnostic pathways is lacking (Hennus et al PLosOne. 2014;
9: e85474, doi 10.1317). The aim of the study was to assess the role of urethrocystoscopy for
ascertainment of infravesical obstruction.
MATERIAL AND METHODS
During the last 6 years 47 boys less than 2 years of age, underwent urethrocystoscopy to complete
diagnostic pathway. Twenty aged 0.2-1.5 (mean 0.8 ± 0.4) with VUR (13 bilateral, 7 unilateral)
mainly grades III - V and 27 aged 0.2-1.6 (mean 0.5 ± 0.4) with dilatation of upper urinary tract/
megaureter (mainly diagnosed prenatally). In all of them VCUG was estimated by experienced
pediatric radiologists (besides the presence of reflux) as normal regarding bladder and urethral
anatomy. Urologic assessment of VCUG results, however, somewhat differs, i.e. characteristic blad-
der neck hypertrophy features and usually slightly dilatation of posterior urethra was found. Almost
half of the patients (11 out 20 and 10 out 27) before cystoscopy underwent urodynamic study, which
revealed elevated voiding pressure and obstructive uroflowmetry pattern.
RESULTS
In all 47 boys cystoscopy performed at mean age of 0.6 years (ranged 0.2-1.6) revealed PUV (in
3 Type III, in the remaining Type I) and transurethral incision usingcold knife was done.
CONCLUSIONS
Our observation suggests that urethrocystoscopy in boys with possible infravesical obstruction
serves as valuable diagnostic procedure.