Congenital Ureteric Valves-a Cause of Urinary Obstruction A Report of 5 Cases

Abstract

Congenital ureteric valves causing upper urinary tract obstruction was discovered after operation in 4 adults who had presented with different urological problems. The fifth patient, an infant, presented with failure to thrive and was suspected of having a congenital ureteric valve prior to operation. The infant had gross hydronephrosis and was treated by excision of the segment containing the valve and end-to-end anastomosis of the ureter and pyeloplasty because of a narrow pelviureteric junction. Three adults had severe kidney damage and underwent nephrectomy. The fourth adult, who had a horseshoe kidney with 4 small stones in the lowermost calix, underwent pyelolithotomy; in addition, the segment bearing the valve was excised and a ureteropyelostomy was carried out.

Pelviureteric junction obstruction in adults: A systematic review of the literature

“…[20] In the small series by Perlberg and Pfau, [18] all 3 cases of obstruction presented were attributed to crossing vessels. All 4 cases in the series by Dajani et al [21] occurred secondary to congenital ureteric valves. Finally, in a series of 17 patients with PUJO reported by David and Lavengood, [22] the causative factor was crossing vessels in 2, periureteral adhesions in 3, ureteric stenosis in 9, and high insertion of the ureter in 3 cases.…”

“…However, our study had a number of limitations, which should be discussed. Despite an extensive literature search and broad inclusion criteria, there is a distinct lack of studies reporting the underlying cause of PUJO in Stern et al [24] 10 6 4 ----Bove et al [17] 11 5 3 3 ---Wadsworth and McClennan [19] 5 1 ----4 Schuster et al [20] 9 7 --6 -3 Perlberg and Pfau [18] 3 3 -----Dajani et al [21] 4 ----4 -David and Lavengood [22] 17 Stern et al [24] LP 6 -Whitaker pressure reduction 6 (100%) 0 -Sivaraman et al [14] RALP 168 39 Resolution on imaging 164 (97.6%) 4-needed 2nd procedure 11 (6.6%) Bove et al [17] LP 11 32.6 "Asymptomatic" 10 (90.9%) 1-no decrease in RFT 2 (18.1%) Wadsworth and McClennan [19] Perlberg and Pfau [18] Vessel transection adults. Consequently, the final sample size was relatively small.…”

“…[25] Nine studies were conducted in the United States, [14][15][16][17]19,20,22,24,25] and the remaining 3 studies were conducted in the United Kingdom, [23] Israel, [18] and Jordan. [21] All the studies were published in English. The methodological characteristics of the included studies are summarized in Table 1.…”

“…The Gold Journal 1.861 Stern et al [24] * / * / * * 4 Sivaraman et al [14] * / * * * * 5 Jacobs et al [15] * / * / / / 2 Richstone et al [16] * / * / * / 3 Boylu et al [25] * * * * * * 6 Bove et al [17] * / * / * * 4 Perlberg and Pfau [18] * / * / / * 3 Wadsworth and McClennan [19] * / * / / / 2 Lacey and Massouh [23] * / * / * * 4 Schuster et al [20] * / * / * * 4 Dajani et al [21] * / * / / / 2 David and Lavengood [22] / / * / * / 2…”

Ablation of Diaphragmatic Annular Ureteral Valve with Holmium Laser

“…These are either seen as single annular lesions with a pinpoint opening, consisting of transverse smooth muscle containing mucosal folds [1] or as eccentric mucosal cusps [2]. They occur equally on either side [3] and may occur at any site in the ureter, less commonly in the midureter and at pelviureteral junction [4]. These lesions may present with flank pain, urinary tract infection, incontinence, hypertension, and hematuria and occasionally with non-functioning kidney requiring nephrectomy [3].…”