title: 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.
authors.affiliation: Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
authors.forename: Taiju
authors.initials: T
authors.lastname: Hyuga
authors.affiliation: Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
authors.forename: Shina
authors.initials: S
authors.lastname: Kawai
authors.affiliation: Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Nakai
mesh_terms: D000293:Adolescent; D002648:Child; D000070621:Cystography; D003558:Cystoscopy; D053207:Diurnal Enuresis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000503:physiopathology*; D014521:Urethra / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014524:Urethral Obstruction / Q000145:classification* / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery