Sonographic features of posterior urethral valves in children and its clinical value.

A retrospective study of transurethral cystoscopy in the diagnosis of 16 cases of urethral valve urethral valve urethral resection in children, analysis of its ultrasonic imaging characteristics, surgery and clinical data.
Research object
Selecting our hospital from January 2014 to March 2018 for ultrasound examination and confirmed by urethral cystoscopy for the diagnosis of post-urethral valve parallel urethral valve resection in 16 children, all male, age 1 day to 10 years old, 10 months, Among them, 13 were younger than 1 year old and 3 were younger than 1 year old. Clinical symptoms: Prenatal development of urinary dysplasia (hydronephrosis, ureteral dilatation, abnormal urethral echo mass) in 9 cases, urinary tract infection in 3 cases, difficulty in urination in 2 cases, urination in 1 case, urinary incontinence in 1 case.
Instruments and methods
(1) The instrument uses the GE VOLUSON E8 and the MINDRAY DC-8 Color Doppler Ultrasound System. It uses a convex array probe (frequency of 6-8 MHz) and a high-frequency linear array probe (frequency of 8-12 MHz) for joint scanning.
(2) Method First take a supine position, observe the situation of the kidneys, ureters and bladder, carefully observe whether there is water in the urinary system, whether the ureteral bladder opening is widened, whether there is thickening of the bladder wall and the formation of trabecular diverticulum and can be observed No posterior urethral dilation. The lithotomy of the child was then examined along the long axis of the urethra through the perineum, showing the entire length of the urethra. Newborns can be directly observed with or without urethral dilatation. When they urinate, check the urinary tract for valvular echoes. During the micturition process, large children need to check the urethra for obstruction and dilatation. At the same time, the neonates can improve the urine without echo. Valve detection.

1. Seen during operation: White valve structures are seen on the distal end of the spermatic spasm. The ventral confluence occurs from the ventral side. The proximal urethra shows dilatation. The bladder neck shows different degrees of elevation. The bladder wall has fibrosis changes. obstruction;
2. Ultrasonography was completely correct in 10 cases. Ultrasound examination showed a complete series of hydronephrosis, dilatation of bilateral ureters, thickening of bladder wall and dilatation of posterior urethra.
3. There were 4 cases of ultrasound diagnosis correctly, ie, the ultrasound showed double hydronephrosis and dilatation of the ureter, but there was no abnormality of the bladder wall and posterior urethral obstruction.
4. Ultrasound diagnosis was misdiagnosed as neurogenic bladder in 2 cases, in which 1 case only showed thickening of the bladder wall, no abnormal sound images were seen in the kidneys, ureters, and urethra; the other case showed mild hydronephrosis in the kidneys. Lateral ureteral dilatation and thickening of the bladder wall;
5. 16 cases had different degrees of hydronephrosis, ureteral hydrops, bladder wall thickening, trabecular lesions, including 14 cases of bilateral hydronephrosis (14/16, 87.5%); bilateral ureteral dilatation in 14 cases (14 /16,87.5%), 1 case of right ureteral dilatation only (urethral ureterogram confirmed as right vesicoureteral reflux), 1 case without ureteral dilatation; 12 cases with thickened bladder lesions; 10 cases with posterior urethral dilatation, including In 5 cases, a clear, strong echogenic membrane structure of the posterior urethra was clearly shown.

1. The observation of the kidneys, ureters, and bladder by transabdominal ultrasonography showed varying degrees of obstruction in the presence of varying degrees of renal pelvis and ureteral hydronephrosis. The majority of cases showed bilateral and a few showed unilateral. The ureter was dilated and showed throughout the course that the bladder was over-filled, the bladder wall was thickened, and the inner wall was not bright. It was seen that the trabeculae or diverticulum was formed. The above changes were highly suspect of the presence of lower urinary tract obstruction.
2. The urethra is further explored through the perineum. During the urination state, the proximal urethra of the membrane is widened, and the distal end is wilting or slightly filling. In order to determine the posterior urethral obstruction, prompted the urethral valve. When there is a small amount of fluid filling in the distal urethra of the obstruction, it can be clearly observed that the membrane structure of the strong echo swings with the urethral muscles.
3. Analysis of misdiagnosis and missed diagnosis: Two children with younger age (<1 year old) could not cooperate with urination and caused difficulty in diagnosis; 2 patients had indwelling catheters and no extubation during ultrasound examination. The posterior urethral structure showed incomplete; 2 cases of children with ultrasound showed only thickened bladder lesions, no abnormalities were seen in both kidneys, ureter and urethra, and the other showed hydronephrosis and right ureteral dilatation. Bladder thickening lesions were diagnosed by a sonographer in a subjective diagnosis of a neurogenic bladder in the 2 cases. The urethra was not examined and the diagnosis was misdiagnosed.

Transperineal ultrasound is simple and easy to perform. It can clearly observe the child's urethra and even see the valve structure directly. Suitable for any child, especially newborns. Can be used as a preferred check for posterior urethral valves. Expansion of the upper urinary tract, thickening of the bladder wall, trabecular lesions, and posterior urethral dilatation are important signs suggestive of posterior urethral valves.