Lack of consensus in atypical congenital obstructive urethral lesions in children: Snapshot of the web-based ObsCUre (obstruction to the child urethra) study

Abstract

Background: Atypical Congenital Obstructive Urethral Lesions (ACOUL) are uncommon causes of urethral obstruction in children. They include Cobb’s collar or Moorman’s ring, Type III posterior urethral valve (PUV), congenital urethral narrowing and anterior urethral valves. This study is aimed to evaluate the knowledge and current practice amongst clinicians attending to ACOUL. An international online case based questionnaire was performed.

Materials and methods: A survey was administered to members of international urological societies. It included 22 clinical questions on cases with ACOUL (14 questions suitable for statistical analysis) using cases of Type I PUV as controls. Two sets of paired questions evaluated change in opinion(s) after additional information was provided.

Results: One hundred twenty-one participants responded with 71% reporting exposure of less than 5 cases per annum. In questions regarding diagnosis between 11.6% (14/121) and 21.5% (26/121) of participants identified the ACOUL as PUV. Among them, 66% of respondents agreed on ACOUL’s causative role in urethral obstruction. Gini coefficient was consistently lower for ACOUL compared to PUV: diagnosis (mean 0.33 vs. 0.44) and prognosis (0.23 vs. 0.43). High intra-rater concordance (kappa 0.420.57) was observed for paired questions-a mean of 5.79% (7.44% and 4.13% for questions 10 and 12, 16 and 17, respectively) of participants changed their answers from an alternate diagnosis to the correct diagnosis of ACOUL after viewing endoscopic images. High variation in management of ACOUL was noted (Gini 0.51).

Conclusions: This global snapshot survey identified substantial inconsistency among clinicians dealing with ACOUL. Although rarely encountered in clinical practice, better overall education of ACOUL is warranted.

Keywords

Atypical urethral obstruction / Children / ObsCUre study / Urethral obstruction

Author summay

Supplemental Digital Content is available for this article.

Acknowledgments

The authors would like to thank Dr. Grahame Smith (Sydney, Australia) for agreeing to pilot the survey and all members of the YPUC (Young Paediatric Urology Club) for their assistance with survey distribution.

Statement of ethics

Study approval was obtained from the Hunter New England Human Research Ethics Committee, Australia, Reference number 17/07/19/5.12. Participants’ consent were obtained in Question 1, as a preamble to the survey. All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest statement

AA is an editorial board member of Current Urology. This article was accepted after a normal external review. No conflict of interest has been declared by the other authors.

Funding source

None.

Author contributions

All authors contributed equally in this study.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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