Clinical Study of Posterior Urethral Valves
Background: Posterior urethral valves are the commonest structural cause of urinary outflow obstruction in boys.(1) It is also the most common type of obstructive uropathy leading to childhood renal failure.Aims and Objectives: To observe the clinical, biochemical and imaging patterns of posterior urethral valves and how they change after initial treatment and during follow up.To review the results of Primary valve ablation and Vesicostomy in management of Posterior urethral vales Materials and methods:We prospectively studied 28 patients from October 2015 to September 2017 with posterior urethral valves who were primarily treated at our hospital or referred from other hospitals for subsequent therapy.
Results: Only two patients (i.e., 7.14%)had a prenatal diagnosis as part of antenatal ultrasound examination. Decreased urinary stream and straining to void are the most common symptoms in present study. Reflux resolved completely in 7of 16 units (43.75%), reduced in grade in 3 of 16 units (18.75%) and remained unchanged in 6 out of 16 units (37.5%).In the present study 10.71% of patients had CRF, whose age at presentation was more than 5 years of age. All these patients had serum creatinine at presentation > 2 mg/dl.Conclusion: In any male child with bilateral hydroureteronephrosis & distended bladder on ultrasonography, a diagnosis of PUV should be entertained.The management of PUV at the first outset should be, urethral catheterization, stabilization of general condition, followed by primary valve ablation.The shortterm results of Primary valve ablation are good.Vesicostomy is equally effective. Reflux tends to disappear or decrease in grade in majority following appropriate surgical management.Delay in diagnosis results in poor outcome of renal function.A much longer period of follow up is needed to understand the longterm results.
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