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[Valves of the posterior urethra in children]
Insights
Transurethral electroresection is the most effective treatment for posterior urethral valves in children. Many upper urinary tract complications resolve spontaneously after this procedure.
Area of Science:
- Pediatric Urology
- Pediatric Surgery
Background:
- Posterior urethral valves (PUV) are a common cause of infravesical obstruction in male infants.
- Diagnosis and management of PUV are crucial for preventing long-term renal damage.
Purpose of the Study:
- To analyze the treatment outcomes of posterior urethral valves in children.
- To evaluate the effectiveness of transurethral electroresection and conservative management strategies.
Main Methods:
- Retrospective analysis of 62 pediatric cases treated between 1988 and 1993.
- Diagnostic methods included urethroscopy, urethrography, and urodynamic tests.
- Treatment involved transurethral electroresection and expectant policies for specific complications.
Main Results:
- Transurethral electroresection was the most effective treatment for PUV.
- 65% of upper urinary tract complications resolved spontaneously post-resection.
- Conservative management for vesicoureteral reflux and megaureter showed high spontaneous resolution rates.
Conclusions:
- Transurethral electroresection is the gold standard for PUV treatment.
- Conservative management is effective for associated reflux and megaureter in most cases.
- Chronic renal failure prevalence was consistent across different age groups.
Abstract:
The paper reports the analysis of 62 cases of posterior urethra valves treated from 1988 to 1993 in the Central Children's Hospital of Russia. The patients' age ranged from 6 months to 14 years. The patients were examined with the use of urethroscopy, urethrography and urodynamic tests providing accurate differential diagnosis of the urethral valves and other infravesical obstructions. Transurethral electroresection of the valvular cusps proved most effective treatment. There exists high probability of self cure of upper urinary tract complications after the transurethral resection (65%). The expectant policy should be followed in relation to vesicoureteral reflux and megaureter (3-6 and 6-12 months, respectively). The exceptions comprise the cases of the above reflux with marked lateralization, ectopy and exposure of ureteral ostia which are more effectively managed by simultaneous valvular transurethral resection and endoscopic submucous injections of teflon paste underneath ureteral ostia. The study of the prevalence of chronic renal failure suggested a conclusion on its equal occurrence in different age groups.