Posterior Urethral Valves; A single Center Experience|
Mirshemirani, Alireza; Khaleghnejad, Ahmad; Rouzrokh, Mohsen; Sadeghi, Afsaneh; Mohajerzadeh, Leila & Sharifian, Mustafa
Objective: Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in
infancy that impair renal and bladder function. This study was planned to evaluate and record the various
clinical presentations and management, complications, and surgical management and long-term outcome of
Methods: In a retrospective study, 98 patients who have been treated for PUV are evaluated in Mofid
Children’s Hospital from January 2007 to December 2012. Detailed history taken and paraclinical
examinations were performed in each patient and diagnosis was confirmed by voiding-cysto-urethrography
(VCUG). PUV had been ablated in 62 patients by electric hook, and diversion was performed in 42 (42.85%)
cases. Data were analyzed by SPSS software version18.
Findings: Totally 98 patients with mean age at diagnosis 62 (±13) days were included in this study. Fifty
seven cases had been catheterized within one to 6 days of life (mean age one day), PUV was ablated in 62
patients by electric hook, and diversion was performed in 42 cases. The most common symptom in our group
was dribbling poor stream 51% and urinary tract infection (UTI) 40.8%. There was vesico-ureteral-reflux
(VUR) in 61.2%, and hydronephrosis in 82.6%. Most common associated anomaly was kidney anomalies
(multicystic kidney disease and renal agenesis/dysplasia) in 8 (8.2%) patients. Twenty patients had prenatal
diagnosis of PUV. Complication occurred in three (3.1%) patients. Mortality occurred in 5 (5.1%) patients.
Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years).
Conclusion: Urinary drainage by feeding tube in early days of infancy, followed by valve ablation is the best
treatment in PUV, and urinary diversion improves the outcome. VCUG is still the gold-standard imaging
modality for documenting PUVs. The factors like renal dysplasia and UTI have their role in final outcome.
PUV; Urinary Drainage; Valve Ablation; Urinary Diversion; Outcome; Children