Study design, materials and methods
We conducted our retrospective descriptive and analytical study at duration between January 2005 to December 2018 in king Abdulaziz University Hospital, Jeddah, kingdom of Saudi Arabia . We designed our scoring system including the following variables: presence of vesicouretral reflux, bladder wall appearance on Voiding Cystourethrogram (VCUG), initial GFR ,Urodynamic test finding (Detrusor overactivity, Compliance, capacity), and Post voiding residual. Each variable was defined with special scoring system ( table 1). These findings were scored from 1 to 3 according to the presence and degree of pathology. Three urology independent accessors were making scoring system ( consultant ,specialist and resident) to test scoring system reproducibility. Scoring system was correlated with patient outcome which was defined as either good outcome (1) (no need for surgical invasive intervention apart from vulgrations, on medical therapy) or bad outcome (2)(need for dialysis, and/or underwent Augmentation Cystoplasty) .
Results
Total of 132 cases were identified, total of 97 were enrolled after excluding files with missing scoring essential data. The median age was 5 years ( 1-19) , with median initial GFR of 50.Recurrent UTI happened in 26 , CIC was used by 55 patients. Vesicouretral reflex was diagnosed in 51 patient ( 29 unilateral, 22 bilateral), bladder compliance was impaired in 89, and significantly high PVR in 78. Detrusor overactivity more than 40 cmh2o in 73 patients. the appearance of bladder wall on VCUG were smooth in 26, irregular in 20 and trabeculated in 51.Good outcome group where 38 compared to 59 who had bad outcome. Scoring system was the same between all assessors. There was a significant correlation between patients score and their outcome with P value 0.003.
Interpretation of results
More than 60% of our Posterior urethral valve patients had bad outcome. Our scoring system was depending on objective measures which helped to standardize the score and resulted into same scoring results by different independent accessors .The use of our scoring system showed a relation between high score and bad outcome, which may help patient prognosis and in family counseling.