Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses?

Chitrit, Yvon; Korb, Diane; Grapin-Dagorno, C.; Joinau-Zoulovits, Félicia; Vuillard, E.; Paye-Jaouen, Annabel; Peycelon, Matthieu; Belarbi, Nadia; Delezoide, Anne-Lyse; Schmitz, Thomas; El-Ghoneimi, Alaa; Sibony, Olivier; Oury, Jean‐François

doi:10.1002/pd.4868

Cited by 18 publications

(9 citation statements)

References 23 publications

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“…The keyhole sign demonstrated high specificity (74%) but poor sensitivity (48%) for LUTO (Table ). Other studies have reported previously poor accuracy of this ultrasound sign for the prospective diagnosis of LUTO, in particular PUV. It has been hypothesized that a possible explanation for its low reliability is that miscellaneous types of bladder dysfunction, such as detrusor instability and bladder‐sphincter dyssynergia, can cause dilatation of the bladder neck.…”

Section: Discussionmentioning

confidence: 87%

Prenatal diagnosis of LUTO: improving diagnostic accuracy

Fontanella

Duin

Scheltema

et al. 2018

Ultrasound in Obstet & Gyne

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Objective: to propose a clinical score for the optimal antenatal diagnosis of Lower Urinary Tract Obstruction (LUTO) in the second trimester of pregnancy, as alternative to the commonly used ultrasound (US) triad (megacystis, keyhole sign and hydronephrosis). Methods Conclusions:We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared to the classic US triad. Future studies to validate these results are needed in order to refine the antenatal management of LUTO and prevent inappropriate fetal interventions.

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Section: Discussionmentioning

confidence: 87%

Prenatal diagnosis of LUTO: improving diagnostic accuracy

Fontanella

Duin

Scheltema

et al. 2018

Ultrasound in Obstet & Gyne

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“…Of these papers, 594 were excluded based on exclusion criteria. A total of 46 studies were ultimately included in the Bayesian meta‐analysis (Table ) 8,9,16–59 …”

Section: Resultsmentioning

confidence: 99%

Predictive accuracy of prenatal ultrasound findings for lower urinary tract obstruction: A systematic review and Bayesian meta‐analysis

Keefe

Kim

Mackay³

et al. 2021

Prenatal Diagnosis

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Background Lower urinary tract obstruction (LUTO) is a rare but critical fetal diagnosis. Different ultrasound markers have been reported with varying sensitivity and specificity. Aims The objective of this systematic review and meta‐analysis was to identify the diagnostic accuracy of ultrasound markers for LUTO. Materials and Methods We performed a systematic literature review of studies reporting on fetuses with hydronephrosis or a prenatally suspected and/or postnatally confirmed diagnosis of LUTO. Bayesian bivariate random effects meta‐analytic models were fitted, and we calculated posterior means and 95% credible intervals for the pooled diagnostic odds ratio (DOR). Results A total of 36,189 studies were identified; 636 studies were available for full text review and a total of 42 studies were included in the Bayesian meta‐analysis. Among the ultrasound signs assessed, megacystis (DOR 49.15, [15.28, 177.44]), bilateral hydroureteronephrosis (DOR 41.33, [13.36,164.83]), bladder thickening (DOR 13.73, [1.23, 115.20]), bilateral hydronephrosis (DOR 8.36 [3.17, 21.91]), male sex (DOR 8.08 [3.05, 22.82]), oligo‐ or anhydramnios (DOR 7.75 [4.23, 14.46]), and urinoma (DOR 7.47 [1.14, 33.18]) were found to be predictive of LUTO (Table 1). The predictive sensitivities and specificities however are low and wide study heterogeneity existed. Discussion Classically, LUTO is suspected in the presence of prenatally detected megacystis with a dilated posterior urethra (i.e., the keyhole sign), and bilateral hydroureteronephrosis. However, keyhole sign has been found to have modest diagnostic performance in predicting the presence of LUTO in the literature which we confirmed in our analysis. The surprisingly low specificity may be influenced by several factors, including the degree of obstruction, and the diligence of the sonographer at searching for and documenting it during the scan. As a result, providers should consider this when establishing the differential for a fetus with hydronephrosis as the presence or absence of keyhole sign does not reliably rule in or rule out LUTO. Conclusions Megacystis, bilateral hydroureteronephrosis and bladder wall thickening are the most accurate predictors of LUTO. Given the significant consequences of a missed LUTO diagnosis, clinicians providing counselling for prenatal hydronephrosis should maintain a low threshold for considering LUTO as part of the differential diagnosis.

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“…The main US findings suggestive for PUV are bilateral hydronephrosis, dilated bladder with a thickened wall (>3 mm) and a dilated posterior urethra (keyhole sign) (22). Furthermore, oligo/anhydramnios can also be present.…”

Section: Prenatal Diagnosis and Managementmentioning

confidence: 99%

Posterior urethral valves: Role of prenatal diagnosis and long-term management of bladder function; a single center point of view and review of literature

Pellegrino

Capitanucci²,

Forlini³

et al. 2023

Front. Pediatr.

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Posterior Urethral Valves (PUV) are the most common cause of lower urinary tract obstruction. More severe forms are detected early in pregnancy (mainly type I), while other forms are usually discovered later in childhood when investigating lower urinary tract symptoms. Bladder dysfunction is common and is associated with urinary incontinence in about 55% (0%–72%). Despite the removal of the obstruction by urethral valve ablation, pathological changes of the urinary tract can occur with progressive bladder dysfunction, which can cause deterioration of the upper urinary tract as well. For this reason, all children with PUV require long-term follow-up, always until puberty, and in many cases life-long. Therefore, management of PUV is not only limited to obstruction relief, but prevention and treatment of bladder dysfunction, based on urodynamic observations, is paramount. During time, urodynamic patterns may change from detrusor overactivity to decreased compliance/small capacity bladder, to myogenic failure (valve bladder). In the past, an aggressive surgical approach was performed in all patients, and valve resection was considered an emergency procedure. With the development of fetal surgery, vesico-amniotic shunting has been performed as well. Due to improvements of prenatal ultrasound, the presence of PUV is usually already suspected during pregnancy, and subsequent treatment should be performed in high-volume centers, with a multidisciplinary, more conservative approach. This is considered to be more effective and safer. Primary valve ablation is performed after clinical stability and is no longer considered an emergency procedure after birth. During childhood, a multidisciplinary approach (pediatric urologist, nephrologist, urotherapist) is recommended as well in all patients, to improve toilet training, using an advanced urotherapy program with medical treatments and urodynamic evaluations. The aim of this paper is to present our single center experience over 30 years.

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Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses?

Abstract: Prenatal ultrasound may differentiate with reasonable accuracy male fetuses with a postnatal diagnosis of PUV from those with VUR. © 2016 John Wiley & Sons, Ltd.

Cited by 18 publications

References 23 publications

Prenatal diagnosis of LUTO: improving diagnostic accuracy

Prenatal diagnosis of LUTO: improving diagnostic accuracy

Predictive accuracy of prenatal ultrasound findings for lower urinary tract obstruction: A systematic review and Bayesian meta‐analysis

Posterior urethral valves: Role of prenatal diagnosis and long-term management of bladder function; a single center point of view and review of literature

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