Posterior Urethral Valve: Delayed Presentation in Adolescence

Mahadik, Punit; Vaddi, Surya Prakash; Godala, Chandra-Mohan; Sambar, Venkatkrishna; Kulkarni, Sushanth; Gundala, Ramesh

doi:10.5213/inj.2012.16.3.149

Cited by 11 publications

(10 citation statements)

References 10 publications

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“…The presenting symptoms of delayed presentation of PUVs are age-dependent, nonspecific, and were thought to differ from early diagnosed PUV. 17,18 Bomalaski et al reported that the most common presenting symptoms were daytime wetting (60%), UTI (40%), and urinary straining/pain (10%). 4,19 Zornoza et al reported daytime incontinence as the most common symptom in their study involving a total of 8 patients.…”

Section: Discussionmentioning

confidence: 99%

Does Voiding Cystourethrogram Exclude Posterior Urethral Valves in Late Presenting Cases?

et al. 2018

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Introduction Delayed presentation of posterior urethral valves (PUVs) is a rare condition. Presentation and diagnosis of the patients with late PUVs are challenging. Voiding cystourethrogram (VCUG) is mainly practiced. In this study, we aimed to evaluate the children with late-presented PUVs, and the reliability of VCUG in this group. Materials and Methods Between January 2003 and December 2017 records of patients who were diagnosed with late-presented PUVs were analyzed. Delayed presentation of PUV was defined as patients who were diagnosed and treated after infancy. Cases were examined in terms of age at diagnosis, presenting symptoms, urinalysis, urinary ultrasound, urodynamic studies, VCUG, and dimercaptosuccinic acid scintigraphy findings. Postoperative follow-up conditions were also assessed. Results Seventeen boys were diagnosed with late-presented PUVs (mean age was 7.35 years). The most common symptoms at presentation were frequency (58.8%), day and nighttime incontinence (47%), and febrile urinary infection (41%). PUV was noted by VCUG in 10 patients alone. The classical sign of dilated posterior urethra was detected in 9 patients. The 10th patient had posterior urethral irregularity. Urethra could not be evaluated due to unsuccessful voiding in one patient. Six patients had normally appearing urethra on VCUG. Reflux was detected in nine (52.9%) patients. Conclusion Late-presented PUVs may be missed on VCUG. Whether a PUV might be present is crucial in boys with a history of recurrent urinary infection, persistent reflux, and repetitive daytime incontinence. Based on our results, we conclude that cystoscopic examination should be preferred for those cases to diagnose PUVs regardless of VCUG results.

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Section: Discussionmentioning

confidence: 99%

Does Voiding Cystourethrogram Exclude Posterior Urethral Valves in Late Presenting Cases?

et al. 2018

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“… 6 Infants and older children with delayed presentations of urethral valves may present with recurrent urinary tract infections, poor urinary stream, urinary frequency, nocturnal enuresis, urinary incontinence, anemia, and voiding pain or dysfunction. 2 , 4 - 7 , 9 , 11 , 15 , 17 In Odetunde and colleagues’ study of 21 patients with late presentation of PUVs, the median age was 3 years (2 days-13 years), and the mean duration of symptoms before presentation was 2.6 years. 18 Nineteen (91%) patients presented with urosepsis, while 8 (36%) patients presented with significant renal insufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, the diagnosis is missed until adolescence or adulthood when the patient presents with lower urinary tract symptoms. 11 This congenital abnormality of proximal urethral development is theorized to be due to Wolffian duct persistence or congenital obstructive posterior urethral membrane. 7 With an incidence of 1:5000 to 1:25 000 of live births, [2][3][4][5][6]8,9 PUV may lead to renal failure in 25% to 43% of affected patients.…”

Section: Introductionmentioning

confidence: 99%

“…7 With an incidence of 1:5000 to 1:25 000 of live births, [2][3][4][5][6]8,9 PUV may lead to renal failure in 25% to 43% of affected patients. 8,11 First described by Watts in 1906, 12 AUV occur 15 to 30 times less frequently than PUV and are the most common congenital obstructive etiology affecting the male anterior urethra. 13,14 They are posteriorly directed semilunar folds arising from the floor of the anterior urethra.…”

Section: Introductionmentioning

confidence: 99%

“… 7 With an incidence of 1:5000 to 1:25 000 of live births, 2 - 6 ,8,9 PUV may lead to renal failure in 25% to 43% of affected patients. 8 , 11 …”

Section: Introductionmentioning

confidence: 99%

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Delayed Presentation of Urethral Valves: A Diagnosis That Should Be Suspected Despite a Normal Prenatal Ultrasound

Shields

White

Mohamed

et al. 2020

Global Pediatric Health

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Background. Congenital urethral obstruction occurs most frequently as a result of urethral valves. The diagnosis is usually confirmed pre- or neonatally. Though not ideal, delayed diagnosis can occur in childhood, adolescence, or adulthood. Despite a normal prenatal ultrasound, there may still be a delayed diagnosis of urethral valves. Methods. We present 4 patients with delayed diagnosis of posterior urethral valves (PUV) and 1 patient with delayed diagnosis of anterior urethral valves (AUV) who were evaluated by a pediatric urologist at our Institution. We determined the age and symptoms at presentation, physical examination, micturating cystourethrogram (MCU) findings prior to the valve ablation, renal function before and after valve ablation, type of valve ablation, and urine culture and sensitivity. The urological courses following urethral valve ablation including urodynamic study findings are described. Results. The median age at presentation was 33 months. All 5 patients presented with decreased urine output and urinary retention. All 5 patients underwent a MCU that demonstrated bladder trabeculations (3 cases), vesicoureteral reflux (3 cases), and bladder diverticula (2 cases). A urethral valve ablation was performed in all cases. Four patients underwent a renal function panel prior to this procedure, and their serum BUN/creatinine levels decreased 1 day postoperatively. Conclusion. Pediatricians should consider urethral valves as causing urethral obstruction although the prenatal ultrasound may be normal. Early diagnosis and prompt treatment of urethral valves may mitigate the potentially devastating morbidities such as renal failure, congestive heart failure, and respiratory distress that may ensue.

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