Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings

TL;DR

The study examines how the bladder appears on initial imaging in boys with a urinary tract condition and whether this appearance relates to prenatal and early postnatal outcomes.

Contribution

The study identifies that bladder appearance on initial imaging is only weakly linked to prenatal and postnatal outcomes, suggesting the need for additional diagnostic methods.

Findings

Bladder appearance on initial imaging was not associated with prenatal megacystis, abnormal scans, or infection rates.

Normal bladder appearance was linked to early prenatal diagnosis and higher creatinine levels.

Bladder appearance alone may not predict future function, suggesting the need for early urodynamics.

Abstract

Bladder profile in boys with Posterior Urethral Valves can be very varied with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal. Our question was whether appearance, specifically of the bladder, on initial VCUG was correlated to prenatal features and whether it could predict early postnatal outcome.

We used a prospectively gathered database of boys with prenatally suspected PUV. We analyzed whether the appearance, specifically of the bladder, was related to date of prenatal diagnosis, presence of a megacystis on prenatal ultrasound, presence of vesico-ureteral reflux (VUR), presence of abnormal DMSA scan, nadir creatinine or presence of febrile urinary tract infection (fUTI) during the first two years of life.

The database comprised 90 cystograms. 15% of bladders were judged normal/regular, 54 % were small/diverticular and 31% were large/diverticular. Bladder appearance was not associated with presence of prenatal megacystis, abnormal DMSA scan, VUR, nor rate of fUTI. The only significant associations were normal/regular bladder and early prenatal diagnosis (p = 0.04) and normal/regular bladder and elevated nadir creatinine (>75µmol/l) (p = 0.01).

We believe that when focusing solely on the appearance of the bladder, excluding information about the urethra and presence of reflux, the cystogram alone is insufficient to inform on future bladder function. This could be used as an argument in favor of performing early urodynamics in this population.