PUV-(SWRD) score

• 30 Jan 2020 09:41:07 AM
• |Pediatic Urology

Comments(3)

• 

  Dr. Anil Takvani

  30 Jan 2020 03:50:45 PM

  Before SWRD scoring, prof. Mitchel M. proposed bladder scoring based on pre fulguration VCUG, based on that we can have some objective criterias and prediction how bladder is likely to behave in future in that particular case    Bladder score below 4 is of good prognostic  value while above 4 is usually associated with bad outcome   ( Mitchel M.)                  Bladder Score
  Bladder Wall     Smooth wall      Mild trabeculations      Moderate trabeculations      Severe trabeculations      Severe trabeculations+ diverticulum	O          1          2          3          4
  Prostatic Urethra     Normal     Dilated & elongated	0          1
  Bladder Neck     Normal     Hypertrophy	0          1
  Total score=A+B+C	0-6

• 

  Venugopal P

  30 Jan 2020 06:34:34 PM

  Dear All,

  In patients with PUV, persistence of Vesical Dysfunction is managed with surveillance, pharmacotherapy, timed voiding, double voiding, and/or assisted bladder-emptying.

  Anil has raised an important issue concerning the outcome of PUV management. He has provided us two scores – the Mitchell Score and SWRD Score (Niyogi et al (2017). The SWRD Score appear simple is based purely on VCUG appearances.

  Afnan Neyas* et al (2019) has provided the 2^nd study that investigates bladder outcomes using SWRD scores in PUV patients. They have modified the SWRD study. In Niyogi’s initial study, they calculated only one score after the primary intervention when VUD was indicated either for symptoms or as part of routine surveillance at 5–15 years of age. In Niyogi’s study, the median score for patients who required intervention was 2. But in the study of Afnan Neyas* et al, it was 4 prior to intervention. They added eGFR also to give better robustness. https://bmcresnotes.biomedcentral.com/track/pdf/10.1186/s13104-019-4120-8

  In 2019, M Bhanakar et al introduced another scoring system which incorporates 7 variable which included Urodynamics as well.

  This proposed scoring system seems reliable and reproducible for predicting PUV outcome and need for surgical intervention

  Variable	Score 1	Score 2	Score 3
  Vesicoureteral Reflux	No Reflux	Unilateral	Bilateral
  Bladder Wall on 1st VCUG	Smooth	Irregular	Trabeculated
  Initial GFR	Normal	Reduced
  Initial Urodynamics	No DO	DO <40 cmh 20	DO >40 cmh 20
  Post Void Residual	Non Significant		>30 PVR
  Bladder Compliance	Normal		Impaired
  Bladder Capacity	Normal		Small Capacity

  With warm Regards,

  Venu

   

• 

  shriram joshi

  02 Feb 2020 04:20:45 PM

  Dear Venu and Anil,

   Thank you for bringing the SWRD score into discussion. 

  SWRD score is easy to measure, only on a micturating cystogram, available everywhere. Afnan Neyas during his research correlated e-GFR to SWRD score and came with very useful clinical indications for the management of PUV children. Neyas showed a SWRD score of 4 prefulguration and eGFR of 29.1 improved  to SWRD score of 3 and eGFR of 49.9 Both eGFR and SWRD scores can be possible predictors of long term outcome. They also found a negative correlation between baseline SWRD score and last eGFR, showing these can be used as predictors. Higher SWRD score ( 6/7) at presentaton with a low eGFR -- indicates worse prognosis. Although not mentioned specifically, the last combination may require both vesicostomy and fulguration, only fulguration may not be sufficient. 

  
  

  Although in both the papers 

  
  

  The other classification includes more invasive urodynamic studies. Yes it does give a better picture of prognosis. The number of good full urodynamic labs are sparse in our country, and I feel this is not suitable to us.

  
  

  Can I interest the teaching units to look at their puv patients even if retrospectively, 

  and establish Indian standard using Neyas approach ? But please publish this in our IJU./ Indian radiology journal.

  
  

  It is also important that our radiology colleagues look at mcug in puv more carefully and document  SWRD score ! They routinely write the PIRAD score in CT scan, so why can't they study the mcug and give us SWRD score ?

  SSJ