Clinical experience of posterior urethral valves

Nine patients with posterior urethral valves were seen at Chang Gung Memorial Hospital from 1985 to 1992. The age at presentation ranged from five days old to 28 years old. The presenting symptoms and signs included abdominal distension, urinary tract infection, respiratory distress, urinary ascites, and weak stream. Patients were examined by voiding cystourethrography and ultrasonography. Surgical management of these patients included primary valve ablation (three cases), cutaneous vesicostomy plus delayed valve ablation (five cases) and primary valve ablation with delayed ureteral reimplantation (one case). For small infants with posterior urethral valves (five cases), temporary vesicostomy and delayed valve ablation offers excellent results in preventing iatrogenic urethral stricture. However, for older children and young adults, the recommended treatment is primary valve ablation. For seven patients with nadir serum creatinine < 1.0 mg/dL, the renal function remained within the normal range, yet during follow-up, one case had renal insufficiency. Vesicoureteral reflux was found in five cases. Spontaneous resolution was noted in two cases after valve ablation, and three cases were controlled with prophylactic antibiotics. The experience of our series suggests that primary valve ablation may be traumatic to the neonatal urethra and temporary diversion would allow greater renal recovery during the neonatal period. With newer delicate instruments, valve ablation may be performed earlier and as a one-stage operation in the future.