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Posterior urethral valves after infancy-urodynamic consequences

A Krishna1, P Lal, A Gupta

  • 1Division of Paediatric Surgery, Department of Surgery, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi 110 095, India.

Pediatric Surgery International
|August 26, 1998
PubMed
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Late-presenting posterior urethral valves (PUV) can cause upper tract damage due to high bladder pressures. Some patients with PUV escape upper tract damage due to normal bladder dynamics, irrespective of obstruction severity.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Pediatric Surgery

Background:

  • Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
  • Late presentation of PUV beyond infancy is less common but can lead to significant urinary tract complications.
  • Understanding factors influencing upper tract damage in late-presenting PUV is crucial for management.

Purpose of the Study:

  • To identify factors contributing to persistent upper tract back-pressure effects despite adequate valve ablation in children with late-presenting PUV.
  • To investigate factors preserving upper tracts in some patients with untreated obstruction.

Main Methods:

  • Evaluation of six children with PUV diagnosed after infancy.
  • Pre-operative assessment including renal biochemistry, ultrasonography, voiding cystourethrography, and uroflowmetry.

Related Experiment Videos

  • Post-operative urodynamic studies (uroflowmetry, slow-fill cystometry) 6 months after valve ablation, confirmed by urethroscopy.

    • Main Results:

    • Three patients with normal upper tracts showed improved flow rates and normal bladder pressures post-surgery.
    • Three patients had bilateral hydroureteronephrosis, two with chronic renal failure, exhibiting decreased bladder capacity, poor compliance, and significant residual volumes.
    • These findings suggest myogenic detrusor failure in patients with persistent upper tract damage.

    Conclusions:

    • Late-presenting PUV (beyond 5 years) can lead to upper tract deterioration associated with high bladder storage pressures.
    • Some boys with long-standing PUV obstruction may maintain normal upper tracts, linked to normal bladder dynamics unrelated to obstruction severity or duration.