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[Posterior urethral valves. Experience with 21 cases].

T Gotoh1, Y Asano, K Nonomura

  • 1Department of Urology, Hokkaido University School of Medicine.

Nihon Hinyokika Gakkai Zasshi. the Japanese Journal of Urology
|July 1, 1991
PubMed
Summary

Posterior urethral valves in boys can lead to urinary issues. Early valve ablation, especially under age one, improves outcomes and resolves vesicoureteral reflux (VUR).

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Area of Science:

  • Pediatric Urology
  • Congenital Abnormalities
  • Nephrology

Context:

  • Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
  • Long-term sequelae of PUV can significantly impact renal function and urinary tract morphology.
  • Understanding the natural history and treatment outcomes is crucial for pediatric urologists.

Purpose:

  • To analyze the morphological and functional outcomes of the upper and lower urinary tracts after valve ablation in 21 cases of posterior urethral valves.
  • To discuss associated complications such as vesicoureteral reflux (VUR), renal insufficiency, and bladder dysfunction.
  • To evaluate the impact of age at diagnosis and treatment on VUR resolution and renal recovery.

Summary:

  • This study reviewed 21 cases of Type I (Young) posterior urethral valves, with 7 severe cases. Vesicoureteral reflux (VUR) was present in 16 children, frequently on the left side, correlating with renal scarring.

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  • Valve ablation was performed in 17 children, with 8 treated under one year of age. Conservative management of VUR post-ablation showed improvement, particularly in low-grade cases or when ablation occurred before age one.
  • Antireflux surgery was required in 5 children. Dilated upper tracts without VUR resolved post-ablation, but VUR with ureteral orifice abnormalities rarely resolved, and renal function recovery was not observed in such cases.

    • Impact:

    • Early diagnosis and timely valve ablation, particularly before one year of age, are critical for improving outcomes in posterior urethral valves.
    • Conservative management of low-grade VUR following ablation can lead to spontaneous resolution, preserving renal function.
    • Identifying specific ureteral abnormalities may predict poorer outcomes and the need for additional surgical intervention.