Posterior urethral valves (PUV) are now commonly suspected on antenatal ultrasound, but can present with a broad spectrum of severity postnatally. Rarely, the diagnosis is missed until adolescence or adulthood when the patient usually presents with lower urinary tract symptoms. We describe an even rarer case of PUV in a late adolescent who first presented with preserved renal function and urinary incontinence. We review the literature on presentation, natural history and outcomes of both early and late presenting PUV cases.

PurposeTo find the association of trial without catheter (TWOC) outcome for first spontaneous acute urinary retention (AUR) in benign prostatic obstruction with age, prior lower urinary tract symptoms (LUTS), retention volume at catheterization (RV), and size of prostate.MethodsOur prospective observational analytical (interventional) study enrolled 77 cases of spontaneous AUR over 24 months. After clinical evaluation, digital rectal examination, and transabdominal ultrasonography, all patients were catheterized per urethra and their RV was recorded. TWOC was administered after 2 or 3 doses of 0.4 mg tamsulosin-oral absorption control system and after 48-72 hours had passed. A successful endpoint was defined as a maximum flow-rate, >5 mL/sec; voided volume, >100 mL; postvoid residue, <200 mL; and voiding within 6 hours of catheter removal. Data obtained from 58 patients were analyzed after excluding the cases lost to follow-up and secondary exclusion. Age, RV, duration of LUTS, and prostate volume on examination and ultrasonography (PUSG) were recorded and statistically analyzed. Prostate-specific antigen levels were obtained on follow-up and cases of cancer, as seen on transrectal ultrasound-guided biopsy, were secondarily excluded.ResultsThe patients had a mean age of 65.89±8.67 years. Prior LUTS was seen in 35 patients (2.07±2.91 months). The mean PUSG and RV were 46.81±20.58 mL and 854.8±36.26 mL, respectively. Thirty patients underwent a successful TWOC; a mean age of 63.13±8.58 years (mean±standard deviation; unpaired t-test; P=0.0053) and a PUSG of ≤45 mL (Pearson chi-square test; P=0.0427) were significantly associated with a successful outcome.ConclusionsThere is a significant association between TWOC outcome, age (P=0.0053), and PUSG (P=0.0427).

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Background: Although Doppler imaging could be used to predict exact location of perforator, computed tomography angiography (CTA) is necessary in patients needed for reconstruction with free flap from lower extremities. A reported rare case of peronea arteria magna.Objectives: This study is to evaluate necessity of CTA as a planning tool in free flap surgery from lower extremities. Methods: 30 patients (aged 25-45 years) with mandibular benign pathology (ameloblastoma) undergoing free fibula flap for reconstruction over a period of three years were included in study. After preoperative colour Doppler showed appropriate result to harvest free fibula flap. Out of these, one case was diagnosed with peronea arteria magna in which free fibula flap could not be used and reconstruction was done with Recon plate. Results: While, Doppler imaging could be used to predict the exact location of perforator, however this gives no reliable information about size and course of vessels. But, rare diagnosis as peroneal magna could not be evaluated. Conclusion: CTA is a valuable imaging tool for the preoperative assessment of the donor-site vascular supply for lower extremity flaps. It can also reduce intraoperative dissection time and minimises surgical error in the identification of vascular anatomy.