The Endoscopic Morphological Features of Congenital Posterior Urethral Obstructions in Boys with Refractory Daytime Urinary Incontinence and Nocturnal Enuresis

Abstract

Purpose This study aims to evaluate the endoscopic morphological features of congenital posterior urethral obstructions in boys with refractory daytime urinary incontinence and/or nocturnal enuresis.

Patients and Methods A total of 54 consecutive patients underwent endoscopy and were diagnosed with a posterior urethral valve (PUV) (types 1–4). PUV type 1 was classified as severe, moderate, or mild. A transurethral incision (TUI) was mainly performed for anterior wall lesions of the PUV. Voiding cystourethrography and pressure flow studies (PFS) were performed before and 3 to 4 months after TUI. Clinical symptoms were evaluated 6 months after TUI, and outcomes were assessed according to PFS waveform pattern groups (synergic pattern [SP] and dyssynergic pattern [DP]).

Results All patients had PUV type 1 and/or 3 (i.e., n = 34 type 1, 7 type 3, and 13 types 1 and 3). There were severe (n = 1), moderate (n = 21), and mild (n = 25) cases of PUV type 1. According to PFS, SP and DP were present in 43 and 11 patients, respectively. TUI was effective in the SP group and symptoms improved in 77.4 and 69.3% of patients with daytime incontinence and nocturnal enuresis, respectively. Almost no effect was observed in the DP group. A significant decrease in the detrusor pressure was observed at maximum flow rate using PFS in the SP group.

Conclusions PUV type 1 encompassed lesions with a spectrum of obstructions ranging from severe to mild, with mild types whose main obstructive lesion existed at the anterior wall of urethra occurring most frequently in boys with refractory daytime urinary incontinence and/or nocturnal enuresis.

Keywords

daytime urinary incontinence - nocturnal enuresis - posterior urethral valve - transurethral incision - urodynamic study

• References

• 1 Young H, Frontz W, Baldwin J. Congenital obstruction of the posterior urethra. J Urol 1919; 3: 289-365
• 2 Hendren WH. Posterior urethral valves in boys. A broad clinical spectrum. J Urol 1971; 106 (2) 298-307
• 3 Pieretti RV. The mild end of the clinical spectrum of posterior urethral valves. J Pediatr Surg 1993; 28 (5) 701-704 , discussion 704–706
• 4 Nakamura S, Kawai S, Kubo T, Kihara T, Mori K, Nakai H. Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study. BJU Int 2011; 107 (8) 1304-1311
• 5 Peters CA, Bolkier M, Bauer SB , et al. The urodynamic consequences of posterior urethral valves. J Urol 1990; 144 (1) 122-126
• 6 Schober JM, Dulabon LM, Woodhouse CR. Outcome of valve ablation in late-presenting posterior urethral valves. BJU Int 2004; 94 (4) 616-619
• 7 de Jong TP, Kuijper CF, Chrzan R, Dik P, Klijn AJ, Vijverberg MA. Efficacy and safety of urethral de-obstruction in boys with overactive bladder complaints. J Pediatr Urol 2013; 9 (6 Pt B): 1072-1076
• 8 Cobb BG, Wolf Jr JA, Ansell JS. Congenital stricture of the proximal urethral bulb. J Urol 1968; 99 (5) 629-631
• 9 Moormann JG. Congenital bulbar urethral stenosis as a cause of diseases of the urogenital junction [in German]. Urologe A 1972; 11 (3) 157-160
• 10 Dewan PA, Zappala SM, Ransley PG, Duffy PG. Endoscopic reappraisal of the morphology of congenital obstruction of the posterior urethra. Br J Urol 1992; 70 (4) 439-444
• 11 Dewan PA, Keenan RJ, Morris LL, Le Quesne GW. Congenital urethral obstruction: Cobb's collar or prolapsed congenital obstructive posterior urethral membrane (COPUM). Br J Urol 1994; 73 (1) 91-95
• 12 Dewan PA, Pillay S, Kaye K. Correlation of the endoscopic and radiological anatomy of congenital obstruction of the posterior urethra and the external sphincter. Br J Urol 1997; 79 (5) 790-796
• 13 de Jong TP, Radmayr C, Dik P, Chrzan R, Klijn AJ, de Kort L ; Pediatric Urology Club Meeting, Stans, Austria, January 2007. Posterior urethral valves: search for a diagnostic reference standard. Urology 2008; 72 (5) 1022-1025
• 14 Kanematsu A, Tanaka S, Johnin K , et al. A multi-center study of pediatric uroflowmetry data using patterning software. J Pediatr Urol 2013; 9 (1) 57-61
• 15 Nevéus T, von Gontard A, Hoebeke P , et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol 2006; 176 (1) 314-324
• 16 Stephens DF, Smith ED, Hutson JM. Congenital anomalies of the kidney, urinary, and genital tracts. 2nd ed. London: Isis Medical Media Ltd; 1996: 91-112
• 17 Imaji R, Moon DA, Dewan PA. Congenital posterior urethral membrane: variable morphological expression. J Urol 2001; 165 (4) 1240-1242 , discussion 1242–1243
• 18 Hoebeke PB, Van Laecke E, Raes A, Vande Walle J, Oosterlinck W. Membrano-bulbo-urethral junction stenosis. Posterior urethra obstruction due to extreme caliber disproportion in the male urethra. Eur Urol 1997; 32 (4) 480-484