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

Shigeru Nakamura; Taiju Hyuga; Shina Kawai; Taro Kubo; Hideo Nakai

doi:10.1055/s-0035-1563401

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2016; 26(04): 368-375
DOI: 10.1055/s-0035-1563401

Original Article

Georg Thieme Verlag KG Stuttgart · New York

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

Shigeru Nakamura

¹Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan

,

Taiju Hyuga

¹Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan

,

Shina Kawai

¹Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan

,

Taro Kubo

¹Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan

,

Hideo Nakai

¹Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan

› Author Affiliations

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

Full Text

References

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