Posterior urethral valves: a single center experience over 7 years

To evaluate the outcome of management of 65 consecutive children with posterior urethral valves (PUV) using two techniques of valves ablation.

Retrospective review of 65 consecutive children with PUV managed over 7 years. There were two groups based on the methods of valves ablation: either Mohan's urethral valvotome for primary cases or electrocautery fulguration for patient with previous intervention. Serum electrolyte and serial post-void residue (PVR) were monitored in outpatient clinic. Alpha-blockers were started in all cases with high PVR. Management outcome of patient who had valves ablation with Mohan's valvotome were compared with those who had endoscopy fulguration.

Sixty-one patients were regular on follow-up with a median age at presentation of 45 days. Nineteen (31%) patients were diagnosed antenatally. There were 32 refluxing ureters in 26 patients; 58 (95%) underwent primary valve ablation (37 with Mohan's urethral valvotome, 21 fulguration). Reflux disappeared in 10 (36%) refluxing ureters. There were five (8.2%) urethral strictures (all five in fulguration group), eight residual valves (four in each group), and three recurrent urinary tract infections. Three patients had nephrectomy and one patient had renal transplantation. There was no death. The mean serum creatinine for all the patients at presentation and at the last follow-up were 1.2 and 0.5 mg/dl, respectively (P = 0.031). At follow-up, mean PVR of valvotome group was 2.5 ml and fulguration group was 2 ml (P = 0.282). The median follow-up period was 24 months.

Early ablation of PUV and detailed attention to bladder management gives a better outcome. With Mohan's valvotome incidence of stricture is less and incidence of residual valves is comparable to endoscopic ablation of PUV.