PUV-(SWRD) score

Can we have some objective criterias how the urinary bladder of patient of PUV will behave with increase in age?
There is a scoring system based on VUCG findings which can predict hostility of bladder in patients of PUVs.
Radiological bladder abnormalities in boys with posterior urethral valves (PUV) are well recognised; however, the assessment is subjective.
 The shape, wall, reflux and diverticuli (SWRD) score objectively assesses shape, wall, reflux and diverticuli in a simple way. 
This study was undertaken to demonstrate that the SWRD score is reliable, reproducible and correlates with bladder outcome and videourodynamic (VUD) assessment in boys with PUV.

I will post few VCUG prior valve fulguration and few months post fulguration and later how bladder behaved in these patients.

PUV-(SWRD) score


  • Dr. Anil Takvani
    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






    Prostatic Urethra


        Dilated & elongated



    Bladder Neck





    Total score=A+B+C


  • Venugopal P
    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 2nd 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


    Score 1

    Score 2

    Score 3

    Vesicoureteral Reflux

    No Reflux



    Bladder Wall on 1st VCUG




    Initial GFR




    Initial Urodynamics

    No DO

    DO <40 cmh 20

    DO >40 cmh 20

    Post Void Residual

    Non Significant


    >30 PVR

    Bladder Compliance




    Bladder Capacity



    Small Capacity

    With warm Regards,



  • shriram joshi
    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 ?

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