[Operative therapy in boys with posterior urethral valves. How much is sensible?]

From 1976 to 1983 23 boys with posterior urethral valves were seen. Two boys died during early infancy from terminal renal failure. One boy is submitted to a chronic peritoneal dialysis program. Of the remaining 20 patients ten show signs of compensated renal failure (creatinine greater than 1.5 mg/dl), ten boys show normal renal function. Four out of 46 kidneys were removed. Vesicoureteral reflux was primarily present in 14 renal units (30.4%). Three of these kidneys were removed. Reflux ceased spontaneously after valve ablation in ten renal units, ureterocystoneostomy was done in one. Ureterovesical obstruction was seen in three renal units and treated by resection and neoimplantation. Renal hypoplasia and -dysplasia together with urinary tract infections determine the degree of renal function impairment in boys with posterior urethral valves. Surgical intervention of the upper urinary tract is seldom needed. Antenatal diagnosis of obstructive uropathy is helpful to avoid septic obstruction in the neonate. Percutaneous nephrostomy is the treatment of choice in critically ill children presenting with dilatation of the upper tracts.