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Published on: January 7, 2019
Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review
Insights
Posterior urethral valves (PUV) management in children shows endoscopic fulguration is effective. Early presentation under 3 months correlates with higher mortality, possibly due to renal dysplasia.
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.
Abstract:
The management of 108 patients with posterior urethral valves from 7 pediatric surgical centers has been reviewed. All the patients have been treated in the 10 year period since 1970. 53 were under 3 mo of age at presentation (Group I), 8 between 3 mo and 1 yr (Group II), 22 between 1 and 5 yr (Group III), and 25 over 5 yr of age (Group IV). Under 5 yr of age urinary infection (37) and renal failure (22) were the commonest methods of presentation. Over 5 yr of age diurnal and nocturnal enuresis were the commonest symptoms. Endoscopic fulguration of the valves with or without preliminary catheter drainage has been the treatment of choice. Repeated fulguration of residual valve cusps was often required. The incidence of urethral stricture (2 patients) was highest after the use of the resectoscope. Refashioning and reimplantation of the ureters is associated with a high complication rate and is not recommended. Secondary operations on the bladder neck have been avoided in this series due to the risk of incontinence. 8 patients died (7.4%) and 7 of these deaths occurred in patients presenting under 3 mo of age. One patient died from renal failure 7 yr after the diagnosis of posterior urethral valves at 2 yr of age. It is suggested that the high mortality from renal failure in the group presenting early is related to renal dysplasia.
