{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:24:07Z","timestamp":1768274647728,"version":"3.49.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T00:00:00Z","timestamp":1692403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T00:00:00Z","timestamp":1692403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009448","name":"Universit\u00e0 degli Studi della Campania Luigi Vanvitelli","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009448","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>To identify the diagnostic performance of clinical and radiological signs (on voiding cystourethrography [VCUG]) to detect posterior urethral valves (PUV) in the post-neonatal period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>One hundred eighteen males (median age\u2009=\u20090.8\u00a0years, range\u2009=\u20091\u00a0month\u201314\u00a0years, 48 toilet-trained) undergoing VCUG in a 2-year period were prospectively enrolled. Direct (dilated posterior urethra) and indirect (hypertrophied bladder neck, musculus interuretericus hypertrophy, and trabeculated appearance of the bladder wall) PUV signs on VCUG were assessed. Uroflowmetry was defined pathological by patterns suggesting infravesical obstruction.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Twenty-two patients with direct, 28 with indirect PUV signs on VCUG, and one with normal VCUG but persisting micturition symptoms with pathological uroflowmetry underwent urethrocystoscopy and in 43\/51 a PUV diagnosis was made (<jats:italic>n<\/jats:italic>\u2009=\u200922, 51.2%, with direct PUV signs). In 8\/28 patients with indirect signs, PUV were not confirmed. Among non-toilet-trained patients, none of the clinical signs\/symptoms was associated with PUV while among toilet-trained patients only pathological uroflowmetry (odds ratio, OR\u2009=\u20094.0 [95% confidence interval:1.2\u201313.2; <jats:italic>p<\/jats:italic>\u2009=\u20090.02]) and pathological uroflowmetry with history of urinary tract infection (OR\u2009=\u2009infinity) were significantly associated with PUV. Significant associations with PUV of direct and indirect signs on VCUG were found both in toilet-trained and non-toilet trained patients. Direct PUV sign had 100% specificity and sensitivity while indirect PUV signs showed sensitivity\u2009=\u200958.1% and specificity\u2009=\u200989.3%. The absence of any radiological sign had a negative predictive value\u2009=\u200998.5%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Only half of patients with endoscopy-confirmed PUV presents with direct sign of PUV on VCUG. Accounting for indirect PUV signs on VCUG and pathological uroflowmetry (in toilet-trained children) could improve the PUV detection rate.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance statement<\/jats:title>\n                <jats:p>Indirect radiological PUV signs should be valorized when interpreting VCUG to improve the PUV detection rate. The absence of any radiological PUV (direct and indirect) sign on VCUG excludes PUV with a very high negative predictive value.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 Worldwide agreement is that a non-dilated urethra on voiding cystourethrography excludes obstruction.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Half of patients with posterior urethral valves have non-dilated urethra on voiding cystourethrography.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Accounting for indirect signs of posterior urethral valves on voiding cystourethrography improves the diagnostic performance.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-023-10126-z","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T05:01:30Z","timestamp":1692421290000},"page":"780-787","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Indirect signs of infravesical obstruction on voiding cystourethrography improve post-neonatal posterior urethral valves detection rate"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-0170","authenticated-orcid":false,"given":"Pierluigi","family":"Marzuillo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Paola","family":"Belfiore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Di Sessa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Torino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnese","family":"Roberti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marialuisa","family":"Balzano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Reginelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Cappabianca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Miraglia del Giudice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"La Manna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Guarino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Di Iorio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,19]]},"reference":[{"key":"10126_CR1","unstructured":"Bingham G, Rentea RM (2022) Posterior urethral valve. Oper Pediatr Surg Seventh Ed 846\u2013861"},{"key":"10126_CR2","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s00345-020-03175-2","volume":"39","author":"B Haid","year":"2021","unstructured":"Haid B, Th\u00fcminger J, Lusuardi L et al (2021) Is there a need for endoscopic evaluation in symptomatic boys with an unsuspicious urethra on VCUG? A consideration of secondary radiologic signs of posterior urethral valves. World J Urol 39:271\u2013279","journal-title":"World J Urol"},{"key":"10126_CR3","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1038\/pr.2014.134","volume":"76","author":"D Thakkar","year":"2014","unstructured":"Thakkar D, Deshpande AV, Kennedy SE (2014) Epidemiology and demography of recently diagnosed cases of posterior urethral valves. Pediatr Res 76:560\u2013563","journal-title":"Pediatr Res"},{"key":"10126_CR4","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1016\/j.urology.2008.04.037","volume":"72","author":"TPVM de Jong","year":"2008","unstructured":"de Jong TPVM, Radmayr C, Dik P et al (2008) Posterior urethral valves: search for a diagnostic reference standard. Urology 72:1022\u20131025","journal-title":"Urology"},{"key":"10126_CR5","unstructured":"Radmayr C, Bogaert G, Dogan HS, et al (2019) EAU guidelines on paediatric urology. Eur Assoc Urol 30\u201338"},{"key":"10126_CR6","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1055\/s-0038-1672146","volume":"29","author":"MA \u00d6zen","year":"2019","unstructured":"\u00d6zen MA, Ta\u015bdemir M, G\u00fcndo\u01e7du G et al (2019) Does voiding cystourethrogram exclude posterior urethral valves in late presenting cases? Eur J Pediatr Surg 29:85\u201389","journal-title":"Eur J Pediatr Surg"},{"key":"10126_CR7","doi-asserted-by":"publisher","first-page":"e20162590","DOI":"10.1542\/peds.2016-2590","volume":"138","author":"D Frimberger","year":"2016","unstructured":"Frimberger D, Mercado-Deane M-G, SECTION ON UROLOGY, SECTION ON RADIOLOGY (2016) Establishing a standard protocol for the voiding cystourethrography. Pediatrics 138:e20162590\u2013e20162590","journal-title":"Pediatrics"},{"key":"10126_CR8","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/bju.12425","volume":"113","author":"SS Yang","year":"2014","unstructured":"Yang SS, Chiang IN, Hsieh CH, Chang SJ (2014) The Tzu Chi nomograms for maximum urinary flow rate (Qmax) in children: comparison with Miskolc nomogram. BJU Int 113:492\u2013497","journal-title":"BJU Int"},{"key":"10126_CR9","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1016\/j.juro.2014.01.110","volume":"191","author":"PF Austin","year":"2014","unstructured":"Austin PF, Bauer SB, Bower W et al (2014) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children\u2019s Continence Society. J Urol 191:1863-1865.e13","journal-title":"J Urol"},{"key":"10126_CR10","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1097\/JU.0000000000001524","volume":"205","author":"P Marzuillo","year":"2021","unstructured":"Marzuillo P, Guarino S, Di Sessa A et al (2021) Congenital solitary kidney from birth to adulthood. J Urol 205:1466\u20131475","journal-title":"J Urol"},{"key":"10126_CR11","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/s00467-016-3373-x","volume":"32","author":"H Pottel","year":"2017","unstructured":"Pottel H (2017) Measuring and estimating glomerular filtration rate in children. Pediatr Nephrol 32:249\u2013263","journal-title":"Pediatr Nephrol"},{"key":"10126_CR12","doi-asserted-by":"publisher","first-page":"179.e1","DOI":"10.1016\/j.jpurol.2015.10.009","volume":"12","author":"AN Bilgutay","year":"2016","unstructured":"Bilgutay AN, Roth DR, Gonzales ET et al (2016) Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol 12:179.e1-179.e7","journal-title":"J Pediatr Urol"},{"key":"10126_CR13","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s10198-016-0830-1","volume":"18","author":"G Turchetti","year":"2017","unstructured":"Turchetti G, Bellelli S, Amato M et al (2017) The social cost of chronic kidney disease in Italy. Eur J Heal Econ 18:847\u2013858","journal-title":"Eur J Heal Econ"},{"key":"10126_CR14","first-page":"1820","volume":"24","author":"Z Gaibie","year":"2020","unstructured":"Gaibie Z, Mahomed N, Petersen KL et al (2020) Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children? SA J Radiol 24:1820","journal-title":"SA J Radiol"},{"key":"10126_CR15","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/j.jpurol.2022.06.002","volume":"18","author":"CQ Wu","year":"2022","unstructured":"Wu CQ, Blum ES, Patil D, Smith EA (2022) Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 18:813\u2013819","journal-title":"J Pediatr Urol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-023-10126-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-023-10126-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-023-10126-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T11:08:50Z","timestamp":1707390530000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-023-10126-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,19]]},"references-count":15,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["10126"],"URL":"https:\/\/doi.org\/10.1007\/s00330-023-10126-z","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,19]]},"assertion":[{"value":"13 April 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The scientific guarantor of this publication is Pierluigi Marzuillo.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional review board approval was obtained (file number 371).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"None.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Prospective\u2022 diagnostic or prognostic observational study\u2022 multicenter study","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}