title: The urethral valve of Guérin and lacuna magna: clinical presentations and urodynamic findings.
abstract: We described the clinical presentations, radiological findings, urodynamic patterns and endoscopic management in a series of patients with symptomatic lacuna magna (LM). The medical records of 14 boys diagnosed as LM were reviewed, retrospectively. The presence of LM was first diagnosed based on clinical history, physical exam, and radiological findings; then confirmed by urethroscopy. Urodynamic study was performed in 10 boys before and after the procedure. Transurethral incision and fulguration of the valve was performed in all patients. The mean (range) age of patients was 3.1 years (6 months to 8 years). The boys presented with dysuria (n = 9), postvoid dribbling (n = 4), hematuria (n = 3), bloody spotting (n = 3), enuresis (n = 4), and glanular irritation and pain (n = 6). The post-operative period was uneventful in all patients. The symptoms were relieved and repeat radiological exam showed complete resolution of LM in all children by the 3rd post-surgical month. Before the procedure, main urodynamic abnormalities in children were high P(detmax) and detrusor instability that significantly improved within 3-6 months after treatment. Despite evidence suggesting that a LM is a frequent, normal anatomical variant, the valve may cause symptoms such as intermittent hematuria, dysuria, and bloody spotting of underwear. The lesion may be associated with obstructive urodynamic patterns in some children. Endoscopic treatment of patients effectively relieves the symptoms and corrects the urodynamic abnormalities.
authors.affiliation: Pediatric Urology Research Center, Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Azadeh
authors.initials: A
authors.lastname: Elmi
authors.forename: Seyedmehdi
authors.initials: S
authors.lastname: Payabvash
authors.forename: Alireza
authors.initials: A
authors.lastname: Sina
authors.forename: Hamid
authors.initials: H
authors.lastname: Arshadi
authors.forename: Zhina
authors.initials: Z
authors.lastname: Sadeghi
mesh_terms: D002648:Child; D002675:Child, Preschool; D053159:Dysuria / Q000209:etiology; D004775:Enuresis / Q000209:etiology; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010146:Pain / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D014522:Urethral Diseases / Q000175:diagnosis* / Q000601:surgery; D014563:Urodynamics