Computational fluid dynamics modeling approaches to assess lower urinary tract hydraulic dynamics in posterior urethral valve before and after endoscopic valve ablation: a pilot study.

Abstract

Computational fluid dynamics (CFD) has been used successfully in cardiovascular system research to analyze the physiological processes inside vessels. We evaluated the hydraulic information of urine through the lower urinary tract in a patient with posterior urethral valve (PUV) before and after valve ablation by CFD. A set of models of the lower urinary tract were developed based on geometrical data obtained by cystoscopy and voiding cystourethrography. Simulated assumptions and conditions were applied according to prior studies and urodynamic results. We used Fluent CFD 19.0 (Ansys Inc., USA) to compute the velocity and pressure of the fluid regions. The simplification of Bernoulli's formula was applied afterward to calculate the hydraulic energy of different positions. The urine flow rates of the NORMALst, the PUVst, and the POSTst at 5000Pa were 18.08ml/s, 11.14ml/s, and 12.16ml/s, respectively. Precipitous pressure change was observed around the valve in the PUVst, and the abnormal change was concentrated in the dilated urethra in the POSTst. Major energy dissipations were generated around the valve and the dilated urethra in the PUVst. The energy loss that occurred in the dilated urethra did not improve after the operation. Our findings are probably indicative of the hydrodynamics changes in the dilated urethra in PUV and need to be confirmed through more improved CFD models in the future. CFD may revolutionize pediatric urologists' perception in the management of urinary disease.