[Obstructive posterior urethral valves. A series of 82 cases]

The authors report their experience gained from a series of 82 cases of severe posterior urethral valves with distension of the upper urinary tract. From analysis of their own series and from a study of the literature, they propose a therapeutic approach to these severe forms. Vesico-ureteral reflux was present in 45% of cases. Once the patency of the bladder neck and urethra was restored, 41% of these cases of reflux disappeared spontaneously and 25% persisted but were well tolerated. Only 13 ureters (29.5%) had to be re-implanted. The cases of ureteral distension without reflux had a similar favourable course after removal of the obstruction of the lower urinary tract. 57% of the dilated ureters resolved or were greatly improved and 11% persisted but were well tolerated. Simple treatment of the valves meant that ureterovesical re-implantation was avoided in 68% of cases. The overall results of uretero-vesical re-implantation were mediocre: out of 32 re-implanted ureters, there were only 15 successes (46.9%), 13 cases (40.6%) were unchanged and there were 4 failures (12.5%). The authors recommend the simple treatment of the posterior valves and suggest careful consideration of the indications for ureterovesical re-implantations in children with abnormal bladder and ureters proximal to the posterior urethral valves.