Congenital posterior urethral valves: problems of management in countries with limited facilities

Abstract

There is scanty reference in the literature from the tropics, especially from Africa, to posterior urethral valves (PUV). The condition is not uncommon in Africans. Forty-five patients seen during a period of 10 years at the Ahmadu Bello University Hospital, Zaria, Nigeria have been analysed in order to discover any problems this abnormality may pose that are peculiar to the developing countries of the tropics. Two-thirds of the patients were under one year of age when first seen, one-third of them being under one month. About a quarter had no urological symptoms at presentation. Most of these were neonates and infants often critically ill due to sepsis and uraemia. These non-urological presentations caused delay in diagnosis and referral with detrimental effects on prognosis. However, the diagnosis could be made on clinical examination by demonstrating a palpable bladder and/or renal masses. Voiding cystourethrogram confirmed the diagnosis when carried out carefully, and required no specialized equipment. Most children were treated satisfactorily by perineal valve ablation, using simple inexpensive instruments. The death rate was high mainly due to delay in diagnosis and in starting appropriate treatment. It is suggested that amongst all who have care of children in the tropics, increased awareness of the varied clinical manifestations of PUV would improve prognosis.

Follow Up With Clinical Characteristics and Somatic Growth in Posterior Urethral Valve

“…Symptoms at presentation in this series agreed maximum with that of Garg et al (1983) and Mirshemirani et al (2013) [13,15] . Dribbling of urine (78%) was the most common presentation in all age groups in this series whereas with advancement of age other common additional symptoms were fever, dysuria, pyuria, pain and palpable mass in abdomen.…”

Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia

“…In Nigeria, PUV is considered to be the most common cause of lower urinary tract anomaly, found in 15% of cases; 9 however, diagnosis is delayed in the neonatal period due to nonurological presentation, and thus mortality (24%) is high. 9 In this study, there was no antenatal diagnosis and around 45.7% had been diagnosed aged >2 years, and thus >60% also received intervention aged >2 years.…”

“…In developing countries, there is scanty reference to PUV and diagnosis is often delayed due to lack of awareness and adequate facilities for investigation. 9 In this study there were no patients with antenatal diagnosis, and most had been diagnosed aged >2 years.…”

“…In a Nigerian study, it was concluded that increased awareness of the condition and its varied clinical presentation will help in early recognition and improvement in prognosis. 9 Following diagnosis, intervention was done at only one center that had a high patient load, thus causing delays.…”