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Anterior deflected urinary stream
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MODEL
Journal of Pediatric Urology (2017) xx, 1
Video Bank
Anterior deflected urinary stream Wisam Abbas a, Mark Woodward a, Mohamed Sameh Shalaby a,b
a
Department of Paediatric Surgery, Bristol Royal Children’s Hospital, Bristol, UK
b
Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt Correspondence to: M.S. Shalaby, Department of Paediatric Surgery, Bristol Royal Children’s Hospital, Upper Maudlin Street, Bristol BS2 8BJ, UK [email protected] (M.S. Shalaby) Keywords Deflected stream; Anteriorly deflected urinary stream; ADUS; Meatal deformity; Meatal shelf; Anterior deflected stream Received 17 April 2017 Accepted 10 August 2017 Available online xxx
Summary We present a case of anterior deflected urinary stream (ADUS) secondary to meatal shelf with no dysfunctional voiding symptoms (DV). The video illustrates the presentation, operative management and literature review. Meatal deformity in girls has been described in association with DV. Hoebeke et al. highlighted the strong correlation between meatal abnormality and non-neurogenic bladder dysfunction in girls.
They demonstrated that girls with ADUS had more severe dysfunction on urodynamics. Klijn et al. prospectively evaluated the effect of surgical meatal correction in girls with ADUS. They found that 39% of female patients with DV had ADUS, 50% of them were free of symptoms following surgical correction. This is the first reported case of an isolated ADUS without DV. Early correction of the anomaly is advocated to limit social distress, and potentially prevent development of DV.
A three-and-a-half-year-old girl presented with an anteriorly deflected urinary stream (ADUS) secondary to a meatal shelf. She could only void standing up, which was causing significant social distress. At presentation she had no symptoms suggestive of dysfunctional voiding (DV). An examination under anesthetic and division of a meatal shelf was performed, with an immediate improvement in the direction of her stream. She was followed up for 10 months with no recurrence of her ADUS. Meatal deformity in girls has been described in association with DV [1,2]. Hoebeke et al. highlighted the strong correlation between meatal abnormality and nonneurogenic bladder dysfunction in girls. They demonstrated that girls with ADUS had more severe dysfunction on urodynamics, and recommended surgical correction of the meatal anomalies to help improve the symptoms. Klijn et al. prospectively evaluated the effect of surgical meatal correction in girls with ADUS [3]. They found that 39% of female patients with dysfunctional voiding had ADUS; 50% of them were free of symptoms following surgical correction, and required no further behavioral therapy. This is the first reported case of an isolated ADUS without dysfunctional voiding, and both the technique of surgical correction and a literature review are presented. Early correction of the anomaly is advocated to limit social distress, and potentially prevent development of dysfunctional voiding.
Funding statement This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interest None declared.
Appendix A. Supplementary data Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j. jpurol.2017.08.008.
References [1] Hoebeke P, Van Laecke E, Raes A, Van Gool JD, Walle JV. Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction. BJU Int 1999; 83:294e8. [2] Hoebeke P, Van Laecke E, Raes A, Walle JV. Hundred consecutive cystoscopic examinations in children. Indications and results. Eur Urol 1996; 30:112e8. [3] Klijn AJ, Bochove-Overgaauw D, WinklerSeinstra PL, Dik P, de Jong TP. Urethral meatus deformities in girls as a factor in dysfunctional voiding. Neurourol Urodyn 2012; 31:1161e4.
http://dx.doi.org/10.1016/j.jpurol.2017.08.008 1477-5131/ª 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Abbas W, et al., Anterior deflected urinary stream, Journal of Pediatric Urology (2017), http:// dx.doi.org/10.1016/j.jpurol.2017.08.008
MODEL
Journal of Pediatric Urology (2017) xx, 1
Video Bank
Anterior deflected urinary stream Wisam Abbas a, Mark Woodward a, Mohamed Sameh Shalaby a,b
a
Department of Paediatric Surgery, Bristol Royal Children’s Hospital, Bristol, UK
b
Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt Correspondence to: M.S. Shalaby, Department of Paediatric Surgery, Bristol Royal Children’s Hospital, Upper Maudlin Street, Bristol BS2 8BJ, UK [email protected] (M.S. Shalaby) Keywords Deflected stream; Anteriorly deflected urinary stream; ADUS; Meatal deformity; Meatal shelf; Anterior deflected stream Received 17 April 2017 Accepted 10 August 2017 Available online xxx
Summary We present a case of anterior deflected urinary stream (ADUS) secondary to meatal shelf with no dysfunctional voiding symptoms (DV). The video illustrates the presentation, operative management and literature review. Meatal deformity in girls has been described in association with DV. Hoebeke et al. highlighted the strong correlation between meatal abnormality and non-neurogenic bladder dysfunction in girls.
They demonstrated that girls with ADUS had more severe dysfunction on urodynamics. Klijn et al. prospectively evaluated the effect of surgical meatal correction in girls with ADUS. They found that 39% of female patients with DV had ADUS, 50% of them were free of symptoms following surgical correction. This is the first reported case of an isolated ADUS without DV. Early correction of the anomaly is advocated to limit social distress, and potentially prevent development of DV.
A three-and-a-half-year-old girl presented with an anteriorly deflected urinary stream (ADUS) secondary to a meatal shelf. She could only void standing up, which was causing significant social distress. At presentation she had no symptoms suggestive of dysfunctional voiding (DV). An examination under anesthetic and division of a meatal shelf was performed, with an immediate improvement in the direction of her stream. She was followed up for 10 months with no recurrence of her ADUS. Meatal deformity in girls has been described in association with DV [1,2]. Hoebeke et al. highlighted the strong correlation between meatal abnormality and nonneurogenic bladder dysfunction in girls. They demonstrated that girls with ADUS had more severe dysfunction on urodynamics, and recommended surgical correction of the meatal anomalies to help improve the symptoms. Klijn et al. prospectively evaluated the effect of surgical meatal correction in girls with ADUS [3]. They found that 39% of female patients with dysfunctional voiding had ADUS; 50% of them were free of symptoms following surgical correction, and required no further behavioral therapy. This is the first reported case of an isolated ADUS without dysfunctional voiding, and both the technique of surgical correction and a literature review are presented. Early correction of the anomaly is advocated to limit social distress, and potentially prevent development of dysfunctional voiding.
Funding statement This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interest None declared.
Appendix A. Supplementary data Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j. jpurol.2017.08.008.
References [1] Hoebeke P, Van Laecke E, Raes A, Van Gool JD, Walle JV. Anomalies of the external urethral meatus in girls with non-neurogenic bladder sphincter dysfunction. BJU Int 1999; 83:294e8. [2] Hoebeke P, Van Laecke E, Raes A, Walle JV. Hundred consecutive cystoscopic examinations in children. Indications and results. Eur Urol 1996; 30:112e8. [3] Klijn AJ, Bochove-Overgaauw D, WinklerSeinstra PL, Dik P, de Jong TP. Urethral meatus deformities in girls as a factor in dysfunctional voiding. Neurourol Urodyn 2012; 31:1161e4.
http://dx.doi.org/10.1016/j.jpurol.2017.08.008 1477-5131/ª 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Abbas W, et al., Anterior deflected urinary stream, Journal of Pediatric Urology (2017), http:// dx.doi.org/10.1016/j.jpurol.2017.08.008