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Editorial comment on “Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves”

      In this interesting paper, the authors have studied the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), posterior-anterior urethral ratio (PA-UR) and bladder trabeculation grade on initial voiding cystourethrogram (VCUG) of children with posterior urethral valve (PUV) and found that only HW-PU significantly correlated with a higher nadir creatinine at one-year of age [

      Wu CQ, Blum ES, Patil D, Smith EA. Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 2022;18:813–9

      ]. Niyogi [
      • Niyogi A.
      • Lumpkins K.
      • Robb A.
      • McCarthy L.
      Cystometrogram appearance in PUV is reliably quantified by the shape, wall, reflux and diverticuli (SWRD) score, and presages the need for intervention.
      ] proposed that in children with PUV increasingly distorted bladder shape was associated with poor bladder dynamics and proposed shape, wall, reflux and diverticuli (SWRD) score. While SWRD scoring system is more subjective, the current paper [

      Wu CQ, Blum ES, Patil D, Smith EA. Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 2022;18:813–9

      ] has combined several useful objective parameters and we commend the authors for this.
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      References

      1. Wu CQ, Blum ES, Patil D, Smith EA. Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 2022;18:813–9

        • Niyogi A.
        • Lumpkins K.
        • Robb A.
        • McCarthy L.
        Cystometrogram appearance in PUV is reliably quantified by the shape, wall, reflux and diverticuli (SWRD) score, and presages the need for intervention.
        J Pediatr Urol. 2017; 13: 265.e1-265.e6https://doi.org/10.1016/j.jpurol.2016.12.005
        • Babu R.
        • Hariharasudhan S.
        • Ramesh C.
        Posterior urethra: anterior urethra ratio in the evaluation of success following PUV ablation.
        J Pediatr Urol. 2016; 12https://doi.org/10.1016/j.jpurol.2016.04.041
        • Babu R.
        • Sai V.
        Bladder height width ratio on voiding cystourethrogram as a predictor of future valve bladder in children with posterior urethral valve.
        Pediatr Surg Int. 2022; 38: 935-939https://doi.org/10.1007/s00383-022-05121-2
        • Jaureguizar E.
        • López-Pereira P.
        • Martinez-Urrutia M.J.
        The valve bladder: etiology and outcome.
        Curr Urol Rep. 2002; 3: 115-120https://doi.org/10.1007/s11934-002-0021-8

      Linked Article

      • Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves
        Journal of Pediatric UrologyVol. 18Issue 6
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          Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood. Bladder and posterior urethral deformity in infants with PUV are highly variable on initial voiding cystourethrogram (VCUG). Some types of deformity may be more important than others in determining the severity of the condition. Identification of specific VCUG features may allow for a simple, early screening assessment for patients.
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      • Response to commentary
        Journal of Pediatric UrologyVol. 18Issue 6
        • Preview
          There are indeed numerous variables to take into consideration with performance and interpretation of a VCUG, especially with the diagnosis of posterior urethral valves. In the current study, the ratios were measured under specific filling and voiding circumstances to reduce the possibility of an erroneous calculation on account of these dynamic factors. We agree that such calculations leave room for variability and can be vulnerable to lack of precision. If the VCUG fails to demonstrate adequate conditions to properly assess the ratios, a fallacious ratio will result.
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