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Posterior urethral valve
Abdulrasheed A Nasir1, Emmanuel A Ameh, Lukman O Abdur-Rahman
1Division of Pediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria. draanasir@yahoo.com
Insights
Posterior urethral valve (PUV) management has improved with earlier diagnosis and surgical techniques. Current trends focus on preserving renal function and bladder health in affected boys.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Technology
Background:
- Posterior urethral valve (PUV) is a primary cause of childhood morbidity, mortality, and progressive renal damage, contributing to end-stage renal disease.
- This condition necessitates a comprehensive understanding of its impact on pediatric renal health.
Purpose of the Study:
- To review and highlight current management strategies for boys diagnosed with posterior urethral valve.
- To discuss the evolving trends in diagnosis and treatment of PUV.
Main Methods:
- A comprehensive literature search was conducted using PubMed/Medline and other bibliographic databases.
- Relevant studies focusing on the presentation, pathology, evaluation, management, and outcomes of PUV were critically reviewed.
Main Results:
- Posterior urethral valve (PUV) diagnosis is increasingly prenatal, with severity varying based on urethral obstruction. Prenatal intervention decisions depend on gestational age, amniotic fluid volume, and fetal renal function.
- Endoscopic ablation is the standard treatment, though alternative methods like Mohan's valvotome are crucial in resource-limited settings. Post-ablation bladder management significantly impacts long-term renal outcomes.
- Proximal urinary diversion is reserved for specific cases of persistent upper tract dilation or deteriorating renal function.
Conclusions:
- Advances in ultrasound, surgical techniques, and neonatal care have improved outcomes for children with posterior urethral valve (PUV).
- Optimal management aims to maximize renal function, preserve normal bladder function, minimize morbidity, and prevent iatrogenic complications.
Background:
Posterior urethral valve (PUV) is a significant cause of morbidity, mortality and ongoing renal damage in children. It accounts for end-stage renal disease in a proportion of children. This article aims at highlighting the current trend in the management of boys with posterior urethral valve.
Data Sources:
PubMed/Medline and bibliographic search for posterior urethral valve was done. Relevant literatures on presentation, pathology, evaluation, management and outcomes of PUV were reviewed.
Results:
PUV which is increasingly diagnosed prenatally presents a spectrum of severity. The varied severity and degree of obstruction caused by this abnormality depend on the configuration of the obstructive membrane within the urethra. The decision to intervene prenatally is dependent on gestational age, amniotic volume, and renal function of fetal urine aspiration. Identification of the patients who may benefit from early intervention remains inconclusive. Endoscopic ablation of the valve is the gold standard of treatment but use of Mohan's valvotome and other modalities are invaluable in developing countries where endoscopic facilities are limited. Proximal urinary diversion may result in poor bladder compliance and should be reserved for patients with persisting or increasing upper urinary tract dilatation, increasing serum creatinine or inappropriate instruments. The behavior of the bladder and its subsequent management after valve ablation may influence the long-term renal outcome in PUV patients.
Conclusions:
The care of children with PUV continues to improve as a result of earlier diagnosis by ultrasound, developments in surgical technique and meticulous attention to neonatal care. The ultimate goal of management should be to maximize renal function, maintain normal bladder function, minimize morbidity and prevent iatrogenic problems.
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