We must compliment Udayshankar
for introducing new concepts in into our understanding of PUV. We thought we
knew most of PUV but recent studies are proving our lack of understanding. Are
we willing to accept some of these new concepts emanating, the answer is both
yes and no. Take for Example the concept of Single leaflet instead of two leaflets
as commonly believed Introduced by Paddy Dewan and confirmed by Lawrence
Baskin. Do we except this concept and the answer is a big NO and we go on with
the concepts as laid down by Young in 1919. Similarly many issues with PUV are
not fully appreciated even now though considerable work has emanated in these
areas. One such addition is provided by Udayshankar for us. In his article he
cites a work of Nobuyuki Hinata and Gen Murakami (2014) which is worth
reading and understanding.
We think that Aggressive treatment of PUV will benefit the
renal functional outcomes and benefit these children. Hideo
Nakai* et al (2017) in an article ask whether such aggressive treatments can become
an aetiology for VUR and Urge incontinence in children. I am providing the link
from which you can gain more information.
many abortive cases of PUV that may not be recognized early in life. Mehmet Ali Özen et al (2019)
concluded by stating that ‘Late-presented PUVs may be missed on VCUG. Whether a
PUV might be present is crucial in boys with a history of recurrent urinary
infection, persistent reflux, and repetitive daytime incontinence. Based on our
results, we conclude that cystoscopic examination should be preferred for those
cases to diagnose PUVs regardless of VCUG results’. Similarly Bernard Haid* et al (2020) in a paper published Online on March 30th
queried whether there is a need for Endoscopic Evaluation in Symptomatic Boys
with an unsuspicious Urethra on VCUG. They brought out the Secondary
Radiological Signs of PUV. They concluded as Mehmet Ali Özen et al that
‘Unsuspicious findings of the urethra on VCUG
cannot exclude a relevant PUV and implicate a risk of disregarding abortive
forms. The presence of secondary radiologic signs of infravesical obstruction
on a VCUG despite an unsuspicious posterior urethra in boys with recurrent
UTI’s as well as refractory symptoms of bladder overactivity or suggestive
signs on sonography must be further clarified endoscopically’.
From the recent studies
pertaining to PUV, it is clear that we will have to understand much more into
various aspects of PUV and not be satisfied only issues concerning Renal
outcomes, however important they maybe.
With warm Regards,
A while ago I had prepared a write up on ‘Development of PUV’
and I am sending it to you for whatever benefits it may have for you.
I hope all will go through the write up and give your valued
comments on the write up.
The article only postulate rhabdomuscle spasm as a cause for high pressures in bladder. They have not presented any concrete evidence to support this theory.