Posterior urethral valve new scoring system: reliability and reproducibility

Banakhar M1, Aljehani A2, Abdulsalam A3, Aljifri H3

Research Type


Abstract Category


Abstract 424
Paediatric Lower Urinary Tract Symptoms and Urinary Incontinence
Scientific Podium Short Oral Session 19
Thursday 5th September 2019
15:00 - 15:07
Hall H2
Bladder Outlet Obstruction Pediatrics Voiding Dysfunction
1.Kind Abdulaziz University Hsopital, 2.kind Abdulaziz University Hospital, 3.King Abdulaziz University Hospital

Mai Banakhar



Hypothesis / aims of study
Posterior urethral valve (PUV) accounts for most cases of lower urinary tract obstruction (LUTO) in new born boys. PUV is a common cause of congenital obstructive nephropathy and impaired bladder function.
To design scoring system which can predict the long term outcomes of posterior urethral valve patients who were diagnosed in King Abdulaziz University Hospital (KAUH).
Study design, materials and methods
We conducted our retrospective descriptive and analytical study at duration  between January 2005 to December 2018 in king Abdulaziz University Hospital, Jeddah, kingdom of Saudi Arabia . We designed   our scoring system including the following variables: presence of vesicouretral reflux, bladder wall appearance on Voiding Cystourethrogram (VCUG),  initial GFR ,Urodynamic test finding (Detrusor overactivity, Compliance, capacity), and Post voiding residual. Each variable was defined with special scoring system ( table 1). These findings were scored from 1 to 3 according to the presence and degree of pathology. Three urology independent  accessors were making scoring system  ( consultant ,specialist and resident) to test scoring system reproducibility. Scoring system was correlated with patient outcome which was defined as either good outcome (1) (no need for surgical invasive intervention apart from vulgrations, on medical therapy) or bad outcome  (2)(need for dialysis, and/or underwent Augmentation Cystoplasty)  .
Total of 132 cases were identified, total of 97 were enrolled after excluding files with  missing scoring essential data.  The median age was 5 years ( 1-19) , with  median initial GFR of 50.Recurrent UTI happened in 26  , CIC was used by 55 patients. Vesicouretral reflex was diagnosed in 51 patient ( 29 unilateral, 22 bilateral), bladder compliance was impaired in 89, and significantly high PVR in 78. Detrusor overactivity  more than 40 cmh2o in 73 patients. the appearance of bladder wall on VCUG were smooth in 26, irregular in 20 and trabeculated in 51.Good outcome  group where 38 compared to 59 who had bad outcome. Scoring system was  the same between all assessors. There was a significant correlation between patients score and their outcome with P value 0.003.
Interpretation of results
More than 60% of our Posterior urethral valve patients had  bad outcome. Our scoring system  was depending on objective measures which helped to standardize the score and resulted into same scoring results by different independent accessors .The use  of our scoring system showed a relation between high score and bad outcome, which  may help patient prognosis and  in family counseling.
Concluding message
Our proposed scoring system  seems reliable and reproducible for predicting PUV outcome and need for surgical intervention. It  needs further studies to test its benefit.It may be used as framework for further studies in this field which might in future  help in counseling family for their children future need for intervention.
Figure 1
  1. Niyogi A, Lumpkins K, Robb A, McCarthy L.Cystometrogram appearance in PUV is reliably quantified by the shape,wall, reflux and diverticuli (SWRD) score, and presages the need for intervention,J Pediatr Urol. 2017 Jun;13(3):265.e1-265.e6. doi: 10.1016/j.jpurol.2016.12.005. Epub 2017 Jan 12.
  2. Lopez Pereira P, Martinez Urrutia MJ, Espinosa L, Lobato R, Navarro M, Jaureguizar E. Bladder dysfunction as a prognostic factor in patients with posterior urethral valves. BJU Int 2002;90: 308e11.
  3. Lopez Pereira P, Martinez Urrutia MJ, Espinosa L, Jaureguizar E. Long-term consequences of posterior urethral valves. J Pediatr Urol 2013;9:590e6
Funding non Clinical Trial No Subjects Human Ethics Committee king Abdulaziz Ethics Committee Helsinki Yes Informed Consent No