Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review

Area of Science:

• Pediatric Surgery
• Urology

Background:

• Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
• Management strategies and outcomes for PUV have evolved over time.

Purpose of the Study:

• To review the management and outcomes of 108 patients with posterior urethral valves treated between 1970 and 1980.
• To identify factors influencing presentation, treatment, and mortality in pediatric PUV patients.

Main Methods:

• Retrospective review of 108 patients from 7 pediatric surgical centers.
• Classification of patients based on age at presentation: <3 months (Group I), 3 months-1 year (Group II), 1-5 years (Group III), >5 years (Group IV).
• Analysis of presenting symptoms, treatment modalities, complications, and mortality.

Main Results:

• Endoscopic fulguration was the primary treatment, often requiring repeat procedures.
• Urethral stricture incidence was higher with resectoscope use.
• Refashioning and reimplantation of ureters and secondary bladder neck operations were associated with high complication rates.
• Overall mortality was 7.4%, with 7 of 8 deaths in infants presenting under 3 months.

Conclusions:

• Endoscopic fulguration is the preferred treatment for pediatric posterior urethral valves.
• Early presentation (<3 months) is associated with significantly higher mortality, likely linked to renal dysplasia.
• Avoidance of ureteral reimplantation and secondary bladder neck surgery is recommended to minimize complications.