Posterior urethral valves: the scenario in a developing center

Abstract

We have reviewed 233 patients with posterior urethral valves treated in a single center in Calcutta, India, over the last 20 years: 37 were neonates, 75 were between 1 and 12 months, 88 were between 1 and 5 years, and 33 were more than 5 years old when first seen. The clinical presentation and methods employed in diagnosis and assessment are described. Primary endoscopic valve ablation was performed in 140 patients (60%). One or other form of diversion was done in 100 (43%), 93 before and 7 either during or after valve ablation. The short- and long-term results have been studied. Eleven patients died during the initial hospitalization, 3 died subsequently, 15 are in end-stage renal disease, 17 are in poor health, and 18 have been totally lost to follow-up. The remaining 169 have been in good health for periods between 1 and 20 years. While our results of primary valve ablation in low-risk patients with responsible parents are as good as anywhere else in the world, we are concerned at our relatively high diversion rate and relatively poor long-term follow up; the methods being adopted to reduce these problems are discussed.

Posterior urethra: Anterior urethra ratio in the evaluation of success following PUV ablation

“…Posterior urethral valve (PUV) is an important cause of obstructive uropathy in boys, and can lead to severe lifethreatening complications like end-stage renal disease [1,2]. Primary valve ablation is the widely accepted treatment modality for newborns with PUV.…”

Reversible, Unilateral Dilatation of Upper Urinary Tract due to a Tight Waist String

“…Unilateral VUR has been described in literature in upto 35% boys with PUV (Posterior Urethral Valves) and is associated with protected renal function [1]. In our case PUV was ruled out by the presence of a normal MCUG and absence of bladder trabeculation and hypertrophy which are typically seen in a valve bladder [2].Transient VUR due to retention of urine could be missed by a delayed MCUG and hence its possibility cannot be ruled out completely. Intermittent ureteropelvic junction obstruction can also present as transient, recurrent hydronephrosis with a characteristic sonographic finding of a thickened pelvic wall seen during recovery [3].…”

Pictorial essay: Congenital anomalies of male urethra in children

“…In high-grade obstruction, a neonate may present with perirenal urinoma, dysplastic kidneys, or urinary ascites. [1415] Nowadays, the entity is termed congenital obstructive posterior urethral membrane (COPUM).…”