Department of Paediatric Urology, Great Ormond Street Hospital NHS Trust, London WC1N 1EH, UK.
J Pediatr Urol. 2011 Apr;7(2):203-8. doi: 10.1016/j.jpurol.2010.04.011.
We routinely perform a cystourethroscopy 3 months after initial ablation of posterior urethral valves. The aim of this study was to determine the predictive value of the urethral appearance on preoperative micturating cystourethrogram (MCUG) for further valve resection at check cystoscopy.
We retrospectively reviewed 31 consecutive boys (aged 4-18 months) who underwent check cystoscopy and repeat MCUG between 2006 and 2008.
Repeat MCUG suggested remnant valves in 10, but no residual leaflets were identified cystoscopically in 4. In 20 boys, the valves appeared completely ablated on MCUG but valve leaflets received further resection in 10. One study was undiagnostic. Residual valves were resected in 83% (5/6) where valves and urethral dilatation were noted on MCUG. Where MCUG suggested either valves or persistent dilatation alone, further resection occurred in 40% (4/10). Remnant leaflets were also present in half of those (7/14) in whom the repeat MCUG had shown complete ablation and resolved/reduced posterior urethral dilatation.
The positive predictive value of valve leaflets and/or posterior urethral dilatation on repeat MCUG for subsequent resection of valve remnants was 56%; the negative predictive value was 50%. We found repeat MCUG alone imprecise in excluding residual valve tissue and recommend check cystoscopy in all.
我们通常在初次消融后 3 个月对后尿道瓣膜进行膀胱尿道镜检查。本研究旨在确定术前排尿性膀胱尿道造影（MCUG）中尿道外观对膀胱镜检查时进一步切除瓣膜的预测价值。
我们回顾性分析了 2006 年至 2008 年间接受膀胱镜检查和重复 MCUG 的 31 例连续男孩（年龄 4-18 个月）。
重复 MCUG 提示 10 例有残余瓣膜，但在 4 例中未在膀胱镜下发现残留瓣膜。在 20 名男孩中，MCUG 显示瓣膜完全消融，但在 10 名男孩中进一步切除了瓣膜叶片。一项研究无法诊断。在 MCUG 提示瓣膜和尿道扩张的 83%（5/6）的病例中进行了瓣膜切除术。在 MCUG 仅提示瓣膜或持续扩张的情况下，进一步切除发生在 40%（4/10）的病例中。在重复 MCUG 显示完全消融且后尿道扩张减轻或消退的 14 例中有一半存在残余瓣叶。
重复 MCUG 上瓣膜叶片和/或后尿道扩张提示随后切除瓣膜残余物的阳性预测值为 56%；阴性预测值为 50%。我们发现单独重复 MCUG 不能准确排除残余瓣膜组织，建议所有患者进行膀胱镜检查。
