Smeulders N, Makin E, Desai D, Duffy PG, Healy C, Cuckow PM et al. The predictive value of a repeat micturating cystourethrogram for remnant leaflets after primary endoscopic ablation of posterior urethral valves. J Pediatr Urol 2011; 7: 203-8.
This study evaluates the predictive value of the micturating cystourethrogram (MCUG) for the presence of residual valves by comparing its findings with that of repeat cystoscopy. The authors consider cystoscopy as the gold standard in this area. They mention that for cystoscopy the inter-observer agreement is fair to good, making it the investigation of choice for diagnosing valves. However, the number of published studies looking at this aspect are relatively few. Moreover, in the study quoted by the authors the good inter-observer agreement is for intact valves and not for residual valves [1]. In our experience, cystoscopy findings for valves are often difficult to interpret, the reasons being the retrograde flow of irrigation fluid that folds the valves over the urethra and the small urethral size. The valves are located at the urethral curve and keeping the endoscope in that position is also sometimes cumbersome. We, therefore, feel that more studies are needed before cystoscopy can be recommended as a routine postoperative evaluation. MCUG is necessary during follow up after valve ablation not only to look for residual valves but also for any change in the degree of vesicoureteral reflux and posterior urethral dilatation. Our contention is that adding repeat cystoscopy