PUV does VCUG give the Correct Diagnosis in all cases

• 05 Oct 2020 09:45:34 AM
• |Pediatic Urology

Dear All,

We have discussed many aspects of PUV but there are many not so common presentations of PUV that we tend to miss and the resultant effect on Renal Function could be deleterious.

 The idea that PUVs may be a spectrum of disease was suggested by Hendren in 1971.  Rafael V Pieretti (1993) discussed the mild end of clinical spectrum of PUV emphasizing that in many PUV’s obstructive features may not be predominant. Bomalaski et al (1999) discussed delayed presentation of PUV and opined that such presentation need not have benign outcomes. Boys with mild valves had a greater frequency of diurnal and nocturnal enuresis, superimposed infection, and a poor stream. Not all VUR we consider Primary are not really primary but could be secondary owing to a missed diagnosis of PUV where Radiological features on VUCG did not suggest the classical findings of PUV. Unfortunately many of us still consider PUV only on VCUG showing the classical findings. This appears to be incorrect as in many PUV’s especially those presenting with late presentation may not reveal the classical findings on VCUG and may even be reported as Normal. I had given a brief write up on this on 25^th June, which I am not repeating. Roy Chally on 6^th September had opined that the article of Uday with his theory explained is not explaining with concrete evidence. The explanation of development of PUV is complex and with varied features of presentation, it is difficult to have any concrete evidence

I am providing the link for two articles and the PDF of one where in some more newer concepts are discussed wherein it has been emphasized that VCUG may not always help in the diagnosis of PUV and its aftermath.  I would appreciate our member to read the comments placed along with Uday Shankar’s post on 14^th June 2020.

https://icurology.org/Synapse/Data/PDFData/2020ICU/icu-58-S46.pdf

https://link.springer.com/article/10.1007/s00345-020-03175-2 (PDF available)

This is an important aspect all of us should realize when dealing with PUV that, though rare, VCUG may not pick up all cases especially in late presentations and a well done Endoscopy is necessary to pick up such PUV’s

With warm Regards

 Venu

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