The primary lesion of posterior urethral valves is a simple one which might be expected to respond readily to simple transurethral resection. Nevertheless, the total care of a boy with urethral valves can be a most complicated undertaking. The object ofthis paper is to describe a new method of valve ablation and to identify and discuss the factors leading to failure of recovery and to persistent urinary infection. From 1951 up to October 1972 boys with posterior urethral valves have been treated by the senior author; of these, 172 presenting before the end of 1970 are available for statistical analysis. PatientsClinical Features Presentation Table I shows the age distribution indicating that just over half the boys presented under I year of age, one-third of them being under 3 months. The mean age of all cases was 23 years. Table I1 shows how the symptomatology varies with the age of presentation : most children have a combination of the symptoms and signs listed. In the older boys infection and incontinence were common; the younger children had more frequently general signs of renal failure. At all ages infection was important and at times seemed to have had a value in drawing the attention of the doctor to the presence of a serious lesion of the urinary tract which might otherwise have escaped notice for some years.Certain misleading presentations may be remarked upon: a number of children had abdominal enlargement apparently due to intestinal distension; in these there was a great deal of oedema on the posterior abdominal wall around infected dilated ureters. Some children had a remarkably good urinary stream, and in them it appeared that massive hypertrophy of the bladder was able to compensate for the obstruction at the expense of very considerable upper tract damage, so that paradoxically some of the children with a good stream had the most serious renal destruction. At other times renal enlargement rather than bladder di: tension was the prominent feature, and with infection there was sometimes a pyonephrosis. DiagnosisThe diagnosis was made in almost all cases by the findings in intravenous pyelography and micturition or expression cysto-urethrography. Any difficulties which arose were in older enuretic children with doubtfully obstructive valves in the posterior urethra, but such cases have been excluded from this series. We are here concerned with unquestionable obstruction. Thus, of 144 boys who survived there were 124 whose pre-operative pyelograms were available for assessment and of these only 22 had normal upper urinary tracts. The remainder had varying degrees of 1This paper formed the basis for

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Two series of primary reconstructions of the classic exstrophied bladder are reviewed and a brief description of the operative procedure is given. There has been a significant improvement in the results since 1963 and a discussion of the possible reasons is given along with a policy for the future.