Ditchfield M R, Grattan-Smith J D, de Campo J F, Hutson J M
Department of Radiology, Royal Children's Hospital, Parkville, Melbourne, Australia.
AJR Am J Roentgenol. 1995 May;164(5):1233-5. doi: 10.2214/ajr.164.5.7717237.
In voiding cystourethrography, the urethral catheter may or may not be left in place during voiding. The main argument for removing the catheter is that the diagnosis of posterior urethral valves may be missed because the catheter can hold open the valve, efface it, and render it invisible. However, if the catheter does not prevent the diagnosis of urethral disease, it is preferable to leave it in place. The catheter makes it possible to repeat the procedure easily if necessary, and using it to drain the bladder provides information about ureteric obstruction in the presence of vesicoureteric reflux. Accordingly, the purpose of this study was to determine whether leaving the urethral catheter in place throughout voiding cystourethrography affects the efficacy of the procedure for the diagnosis of posterior urethral valves.
Three radiologists reviewed the preoperative voiding cystourethrograms obtained in 48 boys who ranged in age from 1 day to 10 years old (mean, 1.5 years). All patients had a diagnosis of posterior urethral valves made at cystoscopy, which was used as the gold standard. The voiding cystourethrogram was obtained with a catheter in place during voiding in 28 (58%) of the 48 boys, without a catheter in 17 (35%), and with and then without a urethral catheter during the voiding phase of the study in three (6%).
Posterior urethral valves were detected on 25 (89%) of the 28 voiding cystourethrograms obtained with a urethral catheter in place and in 15 (88%) of the 17 voiding cystourethrograms done without a urethral catheter. The five children in whom posterior urethral valves had been diagnosed by cystoscopy but were not detected on voiding cystourethrography had no dilatation of the posterior urethra nor any other evidence of obstruction; these were possibly false-positive cystoscopic diagnoses.
Our results show that a urethral catheter does not obscure posterior urethral valves in boys and need not be removed routinely during the voiding phase of voiding cystourethrography.
在排尿性膀胱尿道造影检查中，排尿时尿道导管可留置也可不留置。主张移除导管的主要理由是，导管可能撑开后尿道瓣膜、使其消失从而导致无法发现后尿道瓣膜，进而漏诊。然而，如果导管不会妨碍尿道疾病的诊断，那么最好将其留置。导管使得在必要时能够轻松重复该检查，并且利用其引流膀胱可提供有关存在膀胱输尿管反流时输尿管梗阻的信息。因此，本研究的目的是确定在整个排尿性膀胱尿道造影检查过程中留置尿道导管是否会影响该检查对后尿道瓣膜的诊断效果。
三位放射科医生回顾了48名年龄从1天至10岁（平均1.5岁）男孩的术前排尿性膀胱尿道造影图像。所有患者均经膀胱镜检查确诊为后尿道瓣膜，膀胱镜检查结果作为金标准。48名男孩中，28名（58%）在排尿时留置导管进行排尿性膀胱尿道造影检查，17名（35%）未留置导管，3名（6%）在检查的排尿阶段先留置后又移除尿道导管。
在28例留置尿道导管的排尿性膀胱尿道造影检查中，有25例（89%）检测到后尿道瓣膜；在17例未留置导管的排尿性膀胱尿道造影检查中，有15例（88%）检测到后尿道瓣膜。经膀胱镜检查诊断为后尿道瓣膜但在排尿性膀胱尿道造影检查中未被发现的5名儿童，其后尿道无扩张，也无任何其他梗阻迹象；这些可能是膀胱镜检查的假阳性诊断。
我们的结果表明，尿道导管不会掩盖男孩的后尿道瓣膜，在排尿性膀胱尿道造影检查的排尿阶段无需常规移除。
