Acta Scientific Paediatrics (ISSN: 2581-883X)

Research Article Volume 6 Issue 5

The Outcome of Management of Posterior Urethral Valves

Gajendra Nath Mahato1*, Ipsita Biswas2, Ayub Ali2 and Gouranga Kumar Bose3

1Assistant Professor, Department of Pediatric Urology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
2Associate Professor, Department of Pediatric Urology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
3Associate Professor, Assistant Professor Surgery Sheikh Hasina Medical College, Tangail, Bangladesh

*Corresponding Author: Gajendra Nath Mahato, Assistant Professor, Department of Pediatric Urology, Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh.

Received: April 10, 2023; Published: April 14, 2023

Abstract

Background: The most common cause of bladder outlet obstruction in infancy are Posterior urethral valves (PUV) that impair renal and bladder function. This study was planned to evaluate and record the various clinical presentations and management, complications, surgical management and long-term outcome of PUV.

Aim of the Study: This study was planned to evaluate and record the various clinical presentations, management, complications, surgical management and long-term outcome of PUV.

Methods: In this study total, 49 patients who have been treated for PUV were evaluated in Bangladesh Shishu Hospital and Institute from May 2018 to April 2022. Complete data were taken, paraclinical examinations were performed on each patient and diagnosis was confirmed by micturating-cysto-urethrography (MCU). Posterior urethral valves had been ablated in all patients by the electric hook.

Results: 49 patients with a mean age at diagnosis of 42 ( ± 21) days were included in this study. Catheterization was done within one to 5 days of life in 29 patients. PUV ablated all 49 patients by the electric hook. The most common symptom in our group was dribbling poor stream 71% and urinary tract infection (UTI) 46%. There was vesico-ureteral-reflux (VUR) in 52% and hydronephrosis in 92.5%. The most common associated anomaly was kidney anomalies (Renal agenesis/dysplasia and multicystic kidney disease) in 4 (8.2%) patients. About ten patients had a prenatal diagnosis of PUV. Complications occurred in two (4.2%) patients. Mortality occurred in 3 (6.4%) patients. The mean follow-up period was 3.2 ± 0.8 years (1.5 months to 4 years).

Conclusion: MCU is the gold-standard imaging modality for documenting PUVs. Urinary drainage by catheter in infancy, followed by valve ablation, is the best treatment for PUV. The factors like renal dysplasia and UTI have their role in the outcome.

Keywords: PUV; Urinary Drainage; Valve Ablation; Urinary Diversion; Outcome; Children

References

  1. Smith GH., et al. “The long-term outcome of posterior urethral valves treated with primary valve ablation and observation”. The Journal of Urology5 (1996): 1730-1734.
  2. MALIKQ MA., et al. “Posterior urethral valves”. The Professional Medical Journal4 (2005): 473-478.
  3. Hutton KA. “Management of posterior urethral valves”. Current Paediatrics7 (2004): 568-575.
  4. Hendren WH. “Posterior urethral valves in boys. A broad clinical spectrum”. The Journal of Urology2 (1971): 298-307.
  5. Ricci Z., et al. “Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria”. Nature Reviews Nephrology4 (2011): 201-208.
  6. Goolsby MJ. “National Kidney Foundation Guidelines for chronic kidney disease: evaluation, classification, and stratification”. Journal of the American Academy of Nurse Practitioners6 (2002): 238-242.
  7. Young HH and Davis DM. “The physiology and pathology of micturition. “The practice of Urology”. 1 (1926).
  8. Livne PM., et al. “Genetic etiology of posterior urethral valves”. The Journal of Urology4 (1983): 781-784.
  9. KAJBAFZADEH A. “Congenital urethral anomalies in boys. Part II”. Urology Journal3 (2005): 125-131.
  10. Basak D. “Posterior urethral valves-an enigma”. Journal of Indian Association of Pediatric Surgeons 8 (2003): 130.
  11. Glassberg KI and Horowitz M. “Urethral valve and other anomalies of the male urethra”. Clinical Pediatric Urology. London: Dunitz. (2002): 899-945.
  12. Caione P and Nappo SG. “Posterior urethral valves: long-term outcome”. Pediatric Surgery International 27 (2011): 1027-1035.
  13. Sarhan O., et al. “Prognostic value of serum creatinine levels in children with posterior urethral valves treated by primary valve ablation”. Journal of Pediatric Urology1 (2010): 11-14.
  14. Kaefer M., et al. “Posterior urethral valves, pressure pop-offs and bladder function”. The Journal of Urology2 (1995): 708-711.
  15. Rittenberg MH., et al. “Protective factors in posterior urethral valves”. The Journal of Urology5 (1988): 993-996.
  16. Parag P., et al. “Bilateral high loop ureterostomy in the primary management of posterior urethral valves in a developing country”. Pediatric Surgery International 17 (2001): 157-159.
  17. Kiliś-Pstrusińska K., et al. “Spontaneous Rupture of Kidney Due to Posterior Urethral Valve–Diagnostic Difficulties”. Iranian Journal of Pediatrics3 (2013): 360.
  18. Otukesh H., et al. “Long-term upper and lower urinary tract functions in children with posterior urethral valves”. Journal of Pediatric Urology2 (2010): 143-147.
  19. De Vries SH., et al. “Development of renal function after neonatal urinary ascites due to obstructive uropathy”. The Journal of Urology2 (2002): 675-678.
  20. Choudhury SR., et al. “Parietal wall urinary extravasation and abdominal wall hernia secondary to posterior urethral valves in a neonate”. British Journal of Urology6 (1995): 807-808.
  21. Choudhury SR., et al. “Clinical spectrum of posterior urethral valve obstruction in children”. Journal of Indian Association of Pediatric Surgeons 3 (2003): 148.
  22. Sudarsanan B., et al. “Posterior urethral valves: a single center experience over 7 years”. Pediatric Surgery International 25 (2009): 283-287.
  23. Lal R., et al. “Urethral strictures after fulguration of posterior urethral valves”. Journal of Pediatric Surgery3 (1998): 518-519.
  24. Nanda M., et al. “Mini-vesicostomy in the management of PUV after valve ablation”. Journal of Pediatric Urology1 (2012): 51-54.
  25. Basu AK., et al. “Posterior urethral values: report of a single private clinic in Kolkata”. Journal of Indian Association of Pediatric Surgeons3 (2003): 144.
  26. Shittu OB and Asinobi AO. “Long-term outcome of posterior urethral valve ablation using Mohan's urethral valvotome”. West African Journal of Medicine1 (2004): 35-37.

Citation

Citation: Gajendra Nath Mahato., et al. “The Outcome of Management of Posterior Urethral Valves”. Acta Scientific Paediatrics 6.5 (2022): 21-25.

Copyright

Copyright: © 2023 Gajendra Nath Mahato., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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