Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Pediatr Urol. 2022 Jun;18(3):342.e1-342.e6. doi: 10.1016/j.jpurol.2022.03.021. Epub 2022 Apr 1.
We have recently validated a meatal Stenosis (MS) severity grading system that is based on physical examination.
The study objective was to examine the correlation between this grading system, patients' urinary symptoms, uroflowmetry and postvoid residual parameters.
Patients referred for our clinic for urinary and non-urinary complaints, were prospectively enrolled. Urinary symptoms questionnaire, uroflowmetry parameters and post-voiding residuals (PVR) were assessed, and photographs of the urethral meatus were taken for each patient. The photographs were graded blindly according to the previously validated grading system and correlated with urinary symptoms, uroflowmetry parameters and PVR.
Overall, 75 patients were assessed (20 grade 0, 23 grade 1 and 32 grade 2). When using grade 0 as a reference, the odds ratio (OR) for reporting narrow stream was 6.4 (95%CI 1.65-24.77) and 4 (95%CI 1.18-14.16) for grade 1 and 2 respectively. OR for prolonged urination was 6 (95% CI 1.47-24.89) for Grade 1 and 2; OR for upward stream deviation was10.08 (95%CI -2.43-41.82) for grade 1 and 15.12 (95%CI - 3.74-61.17) for grade 2. Uroflowmetry results showed lower Qmax from 16.8(SD ± 8.0) ml/sec in grade 0-9.6 ml/s on grade 1 and 2 (p < 0.001) (Figure 1). PVR was not statistically different in the three groups.
Our main findings were that meatal stenosis severity grade is associated with narrow stream as reported by parent, prolonged urination, and upward deviation of urinary stream, with increasing severity with worsening stenosis. MS grade was also associated with significant worsening of uroflow measures: a lower Qmax, Qmean and a longer time-to-Qmax. Post-void residual volume was not significantly different between the different severity grades. This study showed the clinical significance of the grading system. With subjective and objective measures. The implementation of this grading system in clinics, may aid in decision making regarding surgical intervention in the appropriate patients, and avoid unnecessary procedures.
The Severity of MS seen on physical examination correlates well with obstructive symptoms and decrease of urine stream seen on uroflowmetry. These findings confirm the importance of the grading system in the evaluation of patients with MS and may be additional measure that assist in consulting parents on the indications to meatotomy.
我们最近验证了一种基于体格检查的尿道外口狭窄（MS）严重程度分级系统。
本研究的目的是探讨该分级系统与患者的尿症状、尿流率和残余尿量之间的相关性。
前瞻性纳入因泌尿系统和非泌尿系统症状就诊于本诊所的患者。评估患者的尿症状问卷、尿流率参数和残余尿量（PVR），并对每位患者的尿道外口进行拍照。照片根据先前验证的分级系统进行盲法分级，并与尿症状、尿流率参数和 PVR 相关联。
共有 75 例患者接受了评估（0 级 20 例，1 级 23 例，2 级 32 例）。当以 0 级作为参考时，报告尿线变细的优势比（OR）分别为 6.4（95%CI 1.65-24.77）和 4（95%CI 1.18-14.16）。1 级和 2 级分别为 6（95%CI 1.47-24.89）和 2 级；1 级和 2 级的尿流向上偏斜的 OR 分别为 10.08（95%CI-2.43-41.82）和 15.12（95%CI-3.74-61.17）。尿流率结果显示，Qmax 从 0 级的 16.8（SD±8.0）ml/sec 降至 1 级的 9.6 ml/s 和 2 级的 2 级（p<0.001）（图 1）。三组之间的 PVR 无统计学差异。
我们的主要发现是尿道外口狭窄严重程度分级与父母报告的尿线变细、排尿时间延长和尿流向上偏斜有关，狭窄程度越严重，症状越严重。MS 分级也与尿流测量的显著恶化相关：Qmax、Qmean 降低，Qmax 时间延长。不同严重程度分级之间的残余尿量无显著差异。本研究显示了分级系统的临床意义。结合主观和客观指标。在临床上实施该分级系统，可能有助于在适当的患者中决定是否进行手术干预，并避免不必要的操作。
体格检查所见的尿道外口狭窄严重程度与尿流率检查所见的梗阻症状和尿流减少密切相关。这些发现证实了分级系统在尿道外口狭窄患者评估中的重要性，并且可能是辅助家长决定是否行尿道外口切开术的另一个指标。
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