Does Voiding Cystourethrogram Exclude Posterior Urethral Valves in Late Presenting Cases?

Introduction Delayed presentation of posterior urethral valves (PUVs) is a rare condition. Presentation and diagnosis of the patients with late PUVs are challenging. Voiding cystourethrogram (VCUG) is mainly practiced. In this study, we aimed to evaluate the children with late-presented PUVs, and the reliability of VCUG in this group. Materials and Methods Between January 2003 and December 2017 records of patients who were diagnosed with late-presented PUVs were analyzed. Delayed presentation of PUV was defined as patients who were diagnosed and treated after infancy. Cases were examined in terms of age at diagnosis, presenting symptoms, urinalysis, urinary ultrasound, urodynamic studies, VCUG, and dimercaptosuccinic acid scintigraphy findings. Postoperative follow-up conditions were also assessed. Results Seventeen boys were diagnosed with late-presented PUVs (mean age was 7.35 years). The most common symptoms at presentation were frequency (58.8%), day and nighttime incontinence (47%), and febrile urinary infection (41%). PUV was noted by VCUG in 10 patients alone. The classical sign of dilated posterior urethra was detected in 9 patients. The 10th patient had posterior urethral irregularity. Urethra could not be evaluated due to unsuccessful voiding in one patient. Six patients had normally appearing urethra on VCUG. Reflux was detected in nine (52.9%) patients. Conclusion Late-presented PUVs may be missed on VCUG. Whether a PUV might be present is crucial in boys with a history of recurrent urinary infection, persistent reflux, and repetitive daytime incontinence. Based on our results, we conclude that cystoscopic examination should be preferred for those cases to diagnose PUVs regardless of VCUG results.

Dimercaptosuccinic acid scintigraphy vs. ultrasound for renal parenchymal defects in children

Introduction: Dimercaptosuccinic acid (DMSA) scintigraphy is the gold standard in the evaluation of renal parenchymal defects and is widely used in the pediatric population. As more recent ultrasound equipment was purchased at our tertiary pediatric centre, our objective was to evaluate if renal ultrasound (US) results are equivalent or sufficient when compared to DMSA scintigraphy in the assessment of renal anomalies.Methods: The charts of all 463 patients who underwent DMSA scintigraphy between January 2009 and May 2014 at our pediatric tertiary centre were reviewed. The objective was to look for correlation between US and DMSA scan results for renal scars/dysplasia. A hundred and sixty pediatric patients followed with US and DMSA scan for a total of 285 renal units remained for evaluation after exclusions. Timing of the exams, urinary tract infection (UTI), and indication for imaging were reviewed. Results with older (105 patients) and newer (55 patients) US equipment were compared.Results: Among the 285 renal units evaluated, 39 (14%) had renal parenchymal defects shown by US and 87 (31%) by DMSA scintigraphy (sensitivity 36%, specificity 96%). The DMSA scan was normal for eight abnormal kidneys (3%) on US. The results were not statistically significant when compared to exams performed with newer or older US machines.Conclusions: At our institution, US data are not sensitive enough to give reliable information about renal parenchymal defects, even with newer equipment. DMSA scintigraphy still remains mandatory for the evaluation of renal anomalies, but could be optional if the US exam indicates parenchymal defects.