Congenital posterior urethral valves: problems of management in countries with limited facilities

There is scanty reference in the literature from the tropics, especially from Africa, to posterior urethral valves (PUV). The condition is not uncommon in Africans. Forty-five patients seen during a period of 10 years at the Ahmadu Bello University Hospital, Zaria, Nigeria have been analysed in order to discover any problems this abnormality may pose that are peculiar to the developing countries of the tropics. Two-thirds of the patients were under one year of age when first seen, one-third of them being under one month. About a quarter had no urological symptoms at presentation. Most of these were neonates and infants often critically ill due to sepsis and uraemia. These non-urological presentations caused delay in diagnosis and referral with detrimental effects on prognosis. However, the diagnosis could be made on clinical examination by demonstrating a palpable bladder and/or renal masses. Voiding cystourethrogram confirmed the diagnosis when carried out carefully, and required no specialized equipment. Most children were treated satisfactorily by perineal valve ablation, using simple inexpensive instruments. The death rate was high mainly due to delay in diagnosis and in starting appropriate treatment. It is suggested that amongst all who have care of children in the tropics, increased awareness of the varied clinical manifestations of PUV would improve prognosis.