Congenital urethral obstruction: the video‐endoscopic perspective

Lu, Yunfan Chris; Dewan, P. A.

doi:10.1111/j.1464-410x.2006.06420.x

Cited by 7 publications

(7 citation statements)

References 37 publications

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“…Compared with prenatal diagnoses or severe infant cases associated with renal/upper urinary tract disorders, however, no consensus has been reached with regard to the importance of relatively mild urethral lesions detected after the onset of urinary symptoms or urinary tract infection in school‐age children as the underlying disease or even with regard to a specific term for this condition. Congenital urethral obstructions reported so far include PUV types 1 to 3 [7], COPUM [8–10], Cobb’s collar [11], Moormann’s ring [12], mini‐valve, congenital bulbar urethral narrowing [13,14] and syringocoele (Cowper’s gland cyst) [15,16]. Agreement has been reached that type 2 PUV is overclassified by Young and does not actually exist [17].…”

Section: Discussionmentioning

confidence: 99%

“…An 8.5‐F or 11.5‐F endoscope (Wolf) was cautiously inserted into the urethra so as not to miss even minor urethral lesions. Congenital urethral obstructive lesions were not classified by Young’s classification [7], but based on the fact that obstruction mainly results from membranous lesions extending down from the anterior urethral wall rather than valvular lesions of PUV, they were classified as follows: congenital obstructive posterior urethral membrane (COPUM) [8–10], which is primarily characterized by membranous lesions projecting from the anterior urethral wall (12 o’clock direction) located in the posterior urethra and connecting with the verumontanum in the 6 o’clock direction (similar to type 1 PUV; Fig. 1A,B); and Cobb’s collar [11], which is characterized by an all‐round septum located at the bulbomembranous junction that does not connect with the verumontanum (similar to type 3 PUV and Moormann’s ring [12]) (Fig.…”

Section: Methodsmentioning

confidence: 99%

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Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? We have clarified that there exist two types of voiding urodynamics (pressure‐flow‐study) for congenital urethral obstruction in boys; one is synergic pattern (SP) and the other is dyssynergic pattern (DP). In terms of daytime incontinence and nocturnal enuresis, the transurethral endoscopic incision of these obstructive lesions is only effective in the SP type, while never effective in the DP type. The synergic pattern (SP) seems to represent simple anatomical obstruction, while the dyssynergic pattern (DP) may represent anatomical obstruction complicated with functional obstruction. The efficacy of endoscopic incision to mild forms of congenital urethral obstruction has been controversial, especially in terms of nocturnal enuresis. One of the reasons for the controversy is due to the lack of pre‐and post‐operative urodynamic assessment with its linkage to symptomatic change. We have, for the first time in the world, systematically conducted voiding urodynamic study for those elusive lesions seen in enuretic boys. Conclusively, for simple mechanical obstruction (SP), we confirmed that some voiding urodynamic parameters improve after the endoscopic incision, parallel to symptomatic improvement, while in the rest (DP) endoscopic incision is never effective. The cause of this ineffectiveness seemed to be due to persistent functional obstruction having superimposed on mechanical obstruction. The result of the study urges us to be more keen to diagnose and treat the mild congenial urethral obstruction as well as the concomitant functional obstruction in boys with nocturnal enuresis. OBJECTIVE • To evaluate the clinical significance of congenital obstructive lesions of the posterior urethra in boys with refractory primary nocturnal enuresis. PATIENTS AND METHODS • VCUG was performed in 43 consecutive boys who visited our department from April 2004 to April 2009 who were unresponsive to conservative treatment. 20 patients of the 43 patients, underwent TUI. VCUG and UDS were performed before and 3–4 months after TUI. • In UDS, the maximum flow rate (Qmax), maximum bladder capacity, and post‐voiding residual urine volume were determined using uroflowmetry (UFM), and the detrusor pressure (Pdet) at Qmax was determined in a pressure flow study (PFS). • Clinical outcome was evaluated 3–4 months and 6 months after TUI. RESULTS • In VCUG performed 3–4 months after TUI, improvement was observed in urethral morphology in all patients. In preoperative PFS, two patterns were observed: 13 patients (65%) had a synergic pattern (SP) in which the Pdet increased with increasing urinary flow rate simultaneously with the initiation of voiding and seven (35%) had a dyssynergic pattern (DP) in which the Pdet was not coincident with the initiation of voiding, but was higher immediately before voiding than at Qmax. TUI was effective only in the SP group: symptomatic improvement was observed in 87.5% of patients with daytime inc...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study

et al. 2010

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“…This, however, may not directly correlate with the degree of obstruction seen on direct endoscope evaluation. 6 It has been shown that patients can be successfully treated with cold knife incision or electrical cautery. The latter is associated with submucosal thermal injury and the development of de novo urethral strictures.…”

Section: Discussionmentioning

confidence: 99%

Urethral obstruction from Cobb's collar in association with VACTERL

Irusen

Moonsamy

Dewan³

et al. 2021

S. Afr. j. surg.

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SUMMARY Cobb's collar is a rare intraluminal congenital cause of bulbar urethral obstruction that is commonly mislabelled congenital obstructive posterior urethral membrane (COPUM) but may be distinguished from this endoscopically as it has no connecting folds to the verumontanum. In this report, Cobb's collar is described for the first time in association with the VACTERL syndrome. The abnormality was diagnosed and treated by diathermy and dilatation at the time of endoscopic evaluation, with improvement of vesicoureteric reflux on micturating cystourethrogram and renal ultrasound. Supplementary video available online: http://sajs.redbricklibrary.com/index.php/sajs/article/view/3527 Keywords: Cobb's collar, VACTERL association, posterior urethral valves, Moormann's ring, COPUM

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“…It has been well documented that even in children with clinically and endoscopically significant PUV, the VCUG picture may be extremely variable. It is not uncommon to find an endoscopically severe PUV with only minimal or moderate posterior urethral dilatation on the VCUG, with a low initial urethral ratio, thus requiring a high index of suspicion to diagnose urethral obstruction [3,4]. In such cases, it is unlikely that urethral ratio would be useful either to diagnose or to test the adequacy of treatment.…”

mentioning

confidence: 95%

Comment on “Urethral ratio on voiding cystourethrogram: A comparative method to assess the success of posterior urethral valve ablation”

Chandrasekharam

2010

Journal of Pediatric Urology

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Congenital urethral obstruction: the video‐endoscopic perspective

Cited by 7 publications

References 37 publications

Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study

Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study

Urethral obstruction from Cobb's collar in association with VACTERL

Comment on “Urethral ratio on voiding cystourethrogram: A comparative method to assess the success of posterior urethral valve ablation”

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