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[Posterior urethral valves. Type of treatment and short- and long-term evaluation of renal function]
Insights
Posterior urethral valves in children were managed with various surgical techniques. Early diagnosis and treatment, particularly in infants, significantly improved renal function and continence, with transurethral valve destruction showing good outcomes.
Area of Science:
- Pediatric Urology
- Surgical Management
- Renal Function Preservation
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants, potentially leading to severe urinary tract damage.
- Management strategies have evolved, impacting long-term renal function and urinary continence.
Purpose of the Study:
- To analyze the management and outcomes of 81 pediatric cases of posterior urethral valves.
- To evaluate the effectiveness of different surgical interventions on renal function and urinary continence.
Main Methods:
- Retrospective analysis of 81 patients with posterior urethral valves (grades 1-4) treated between 1972 and 1985.
- Surgical interventions included transurethral valve destruction, cutaneous vesicostomy, perineal approach valve removal, and ureteric reimplantation.
Main Results:
- 68% of severe valve cases (grade 4) underwent exclusive obstruction removal, with 74% achieving normal renal function post-treatment (vs. 47% pre-treatment).
- Cutaneous vesicostomy was effective in very young infants with severe complications.
- Continence was achieved in all patients over 12-13 years old; only one case of mild urethral stricture was noted.
Conclusions:
- Early diagnosis and treatment of posterior urethral valves, especially in the first months of life, are crucial for optimal renal function.
- Transurethral valve destruction and cutaneous vesicostomy are effective management options for pediatric posterior urethral valves.
- Surgical interventions can restore normal renal function and achieve urinary continence in the majority of affected children.
Abstract:
In this paper the authors have analyzed the management and the outcome of 81 cases of posterior urethral valves which occurred during the period January 1972 - April 1985. 53 children presented very severe urethral valves (grade 4 according to Hendren), 28 mild valve type. All the children of the first group but two had a dilatation of the U.U.T. Vesico-renal reflux, usually severe, was present in 51 ureters; in another 50 ureters a dilatation without reflux was present. 47% of the children of the first group had a renal function within the limits of normality at the moment of presentation and the remaining 53% a reduced renal function. In 9 patients (8 under 50 days of age) a cutaneous vesicostomy according to Blocksom followed, at the age of 10-18 months, by transurethral valve destruction was done. In 6 infants, in the early part of the series, the valve was removed with a hook via the perineal approach. In 38 patients we performed a transurethral valve destruction with the n. 3 Bugbee electrode. 36 out of 53 children (68%) had exclusively a removal of the valvular obstruction. After the removal of the obstruction, 32 out of 37 non refluxing dilated ureters (86.5%) showed a clear improvement. In 7 out of 29 refluxing ureters a nephrectomy was carried out. In the remaining 22 ureters the reflux vanished in 17 and improved in the other 5. 17 children had other types of operations after valvular removal. 23 ureters in 13 patients were reimplanted, with 3 failures (13%). In the 53 children with very severe valve (grade 4) supravesical diversions were not carried out. In the follow-up of 51 children (from 6 month to about 14 years) the renal function was within the limits of normality in 74% (before the operation it was 47%). The best results were obtained in children diagnosed and treated in the first months of life. Cutaneous vesicostomy showed itself to be a very useful method of treatment in very young babies with severe complications. We observed a slight terminal urethral stricture, easily dilatable, in only 1 child. All the children over the age of 12-13 years were continent. In 28 children with mild valves, as well as transurethral valve destruction, an ureteric reimplantation was carried out with success in 5 children (8 ureters) and a vesical diverticulectomy in another 2.