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. 2016 Apr;8(Suppl 2):S109–S115.

Posterior Urethral Valve

PMCID: PMC4869440
Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Posterior urethral valves

F. M. Ayyat

Department of Urology, Dhahran Health Center, Dhahran, Saudi Arabia

Posterior urethral valve (PUV) is a rare congenital disease. Its incidence is unknown but it is estimated to be 1:50000 in male children.

This paper will discuss the presentation of PUV in the different age groups, the surgical treatment, the complications and the prognosis compared to the urological literature.

The controversy of urinary diversion versus undiversion is discussed with the aggressive surgical treatment. Although our series is a small one, it presented the most severe form of the disease which resulted in one death, 7% mortality compared to 41% mortality rate at this age, in the literature. The death was from uremia caused by severe renal dysplasia associated with PUB. Four patients had a single non-functioning unit.

Very young infants are likely to have the most severe form of PUV because of the associated renal dysplasia. Eight patients who presented in the neonatal period had 100% uremia on diagnosis. 75% of them still have mild azotemia. This latter group also have the most severe form of bladder outlet obstruction and reflux.

Presented at the: 4th Saudi Urological Conference Riyadh Central Hospital 18 September 1986

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Prognostic parameters of proterior urethral valve

E. Raboey, S. Jacob

Department of Pediatric Surgery, Hospital Des Enfants Malades, Paris, France

From 1979-1989, 39 babies with PUV were treated in Hospital Des Enfants Malades. During this period, antenatal diagnosis rate increased from 25% to 80%. The follow up time ranged from 2 to 10 years. Not surprisingly, the most unfavourable prognosis was associated with pulmonary-kidney dysplasia. 34 of the 39 children (88%) are known to be alive. Eight patients are living in other countries and their data is based on written information from outside. 26 patients were available for renal function assessment. Nine of them (35%) have some degree of renal failure. None have undergone dialysis or kidney transplant. Prognostic parameters, such as reflux, infection and post-operative Creatinine Level will be discussed.

Presented at the: 6th Saudi Urological Conference National Guard King Khalid Hospital - Jeddah 27-28 November 1991

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Posterior urethral valve in gizan region, our experience

A. Jha, Z. Roshdi, K. S. Abdul Wahab

Department of Surgery, Division of Urology, King Fahad Central Hospital, Gizan, Saudi Arabia

Congenital anomalies of the urinary tract are common in Gizan region of Saudi Arabia, over a period of 10 years. We have studied 21 cases of posterior urethral valve in King Fahad Central Hospital, Gizan, treated with early nephrological and paediatric care to definitive endoscopic valve ablation and in some cases preliminary diversion, prior to endoscopy.

We divided our patients into three broad groups. Group A - Neonates. Group B - Below 2 years. Group C - Above 2 years. Over age of presentation ranged between 20 days to 12 years, average age being 2.62 years. Maximum presentation was below 1 year age (57.1%). Maximum presenting features in Group A was renal failure and septicaemia (66%) in Group B was weak stream (54.8%). Recurrent UTI (19%) and dribbling (19%) while in Group C majority with weak stream (57%) followed by recurrent UTI.

70% in our series were young type I, no correlation with age and type was found. 50.2% had hydronephrosis, 60.1% with bilateral VU reflurx and 9.5% with unilateral reflux. 19% had associated vesical stone.

The overall assessment and the immediate result of cases are discussed and analysed, in comparison with available literature and recommendations made. Poor prognosis was noted in Group A cases of early presentation with renal failure and septicaemia, while best results were noted in Group C cases and moderate results in Group cases.

Presented at the: 7th Saudi Urological Conference Riyadh Armed Forces Hospital 11-12 November 1992

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Posterior urethral valve with stones

K. H. S. Siddiqui, Adel Jamal

Department of Urology, King Khalid National Guard Hospital, Jeddah, Saudi Arabia

Posterior urethral valve usually diagnosed during intrauterine period and in early infancy by antenatal ultrasound of the foetus. It is treated by vasicostomy and laser to prevent reflux and damage to the kidneys.

Looking through the literature as far as I am aware no case of posterior urethral valve with urinary bladder and urethral stones has been reported.

We present this child who was diagnosed as having posterior urethral valve at the age of 22 months and has multiple non radiopaque stones in the bladder and posterior urethra. The child has normal renal functions and has no metabolic disease. Serum uric acid and urates were normal and has only marginally raised urate in 24 hour urine collection.

Posterior urethral valve is successfully fulgurated by endoscopic diathermy loop and the stones were removed by minimally invasive surgery “suprapubic cystoscopic extraction”. The patient has uneventful postoperative recovery and reduces postoperative morbidity by avoiding vasicostomy. Postoperative cystogram did not show any stones. A child has been followed up in the clinic and has no urinary symptoms. Ultrasound examinations of kidney ureter and bladder also did not show any gross abnormality.

Presented at the: 9th Saudi Urological Conference King Fahd Hospital - Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Experience with urethral valvotomy in King Fahd Specialist Hospital - Gassim

Mohan K. Abraham, Jehad Abu Daia, Saidul Islam, Salah El Sayed, Rodney Aguiar

Department of Urology, King Fahd Specialist Hospital, Gassim, Saudi Arabia

Management of posterior urethral valves is difficult especially in new-borns because of low birth weight and very small calibre urethra. Cystoscopy causes over stretching of urethra resulting in strictures. Electrical and thermal burns of urethra at the site of valve fulguration can also result in stricture.

To overcome these problems, urethral valvotome was invented. This has 3 mm outer diameter and does not stretch the urethra. It does not use diathermy and thereby avoid electrical and thermal burns to urethra. It is easy to use and bring down total anaesthesia time to less than ten minutes.

This has been used in six patients in our hospital. Ages varying from one day to two years. Since valvotomy was being used for the first time in this hospital, all patients were cystoscoped with No. 7 cystoscope before valvotomoty to confirm the presence of valves and after valvotomy to confirm that valvotomy has been accomplished. Valvotomy was successful in all patients. Narrowing of the dilated posterior urethra was demonstrated by Micturating Cystourethrogram.

Valvotome was found to be effective, easy to use and without complication. It is recommended for routine use in babies with posterior urethral valves.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital - Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Congenital polyps of the posterior urethra

M. Y. Ezzibdeh, A. Al Dayel, S. Egail, I. Al Oraifi

Department of Surgery, Division of Urology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Congenital polyps of the posterior urethra are defective protrusions of the urethral floor in the area of the verumontanum and are commonly seen in boys from 3 to 9 years old. We report two cases of congenital urethral polyps in 3 and 4 year old boys presented with difficulty in voiding intermittent retention of urine and haematuria. Ultrasonography of the bladder revealed a pedunculated mass at the level of the bladder neck and voiding cystourethrogram showed a filling defect in the posterior urethra. At cystoscopy, a pedunculated polyp arising from the posterior urethra demonstrated and transurethral polypectomy performed with good result.

Posterior urethral congenital polyps should be considered in children with bladder outflow obstruction and transurethral resection is an effective form of treatment.

Presented at the: 7th Saudi Urological Conference Riyadh Armed Forces Hospital 11-12 November 1992

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Diagnosis and treatment of genito-urinary tract anomalies posterior urethral valve as an example

A. Al Jaser, G. M. Rifai, H. Al Faraj, M. Mansour

Department of Urology, Security Forces Hospital, Riyadh, Saudi Arabia

Purpose: Posterior urethral valves occur in spectrum of severity and could lead to death if not diagnosed and treated properly. What is the optimal diagnostic approach? Does early detection leads to early treatment and if so, does it affect the outcome?

Materials and Methods: Thirty-four neonates and child diagnosed to have posterior valve in the period extending from 1987 till 1999 were reviewed retrospectively regarding age at first presentation, mode of presentation, presence of other genito-urinary anomalies, over all prognosis and treatment modalities performed.

Results: The majority of the patients (47%) were presented at first year of life. Poor stream was the most common mode of presentation in 35%, followed by UTI in 26% of cases. Prenatal diagnosis was found in 24% of cases while retention of urine was the first presenting symptom in 9% of cases. The most common associated GU anomalies were UVR in 65% followed by PUJ in 12%. Pulmonary hyperplasia and crypto-orchidism were equal (9%) association with PUV. Fulguration of the PUV was the commonest modality of treatment 82%, were vesicostomy and ureterostomy were performed equally in the rest of the cases. The worst prognostic factor was in those who were diagnosed antenatally, there was three mortality, followed by those groups of older children who presented at age 6 and 5 years with recurrent UTI, two of them progressed to end stage renal disease.

Conclusions: Intra-uterine urinary obstruction destroys both kidneys so that the infant will do poorly despite prompt decompression of urinary tract. The main value of prenatal diagnosis by ultrasound of post urethral valve (and other GUT anomalies) is to make possible early postnatal treatment before severe sequalae occur.

A team approach between the medical staff (radiologist, perinatologist, neonatologist, urologist and nephrologists) with each other prior to delivery to plan further management is a strong recommendation, meanwhile prophylactic antibiotic should be given to any PUV case diagnosed prenatally immediately after delivery till work up is complete.

Presented at the: 13th Saudi Urological Conference Riyadh Armed Forces Hospital 14-17 February 2000 (09-12 Dhu Al Qa’dah 1420)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Long-term follow up of posterior urethral valve

M. S. Abomelha, M. T. Said, A. Al Jutaili, S. A. Orkubi, A. A. Shaaban

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Between 1987-1995, we have treated 220 children with urological anomalies. Posterior urethral valve (PUV) ranked fourth (9%) after PUJ obstruction, reflux and renal dysplasia. 20 boys with proven PUV aged between 1 day and 6 months were treated in our department. Bilateral hydronephrosis was present in 100% of patients while reflux was present in 52.5% renal units.

Poorly functioning kidney was observed in 42.5% renal units. 80% of the children were followed up and 4 children were lost for follow up after the initial diagnosis. The follow up period ranged between 18-100 months (mean 49). The initial treatments offered to those children before valve ablation were: catheter drainage in 5, vesicostomy in 3, unilateral ureterostomy in 3, and bilateral cutaneous ring-ureterostomy in 9 children. The long-term outcome of those followed up was looked at from point of renal function and dilation reflux. The two children with bilateral poor functioning kidneys did not improved and are heading dialysis at age 3 and 8 years. 5 of the 11 poor functioning renal units did improve and only 3 kidneys needed nephrectomy for gross hydronephrosis and infection. Refulx and hydronephrosis did resolve in 2 patients and improve in 12.

We can conclude that PUV ranked 4th among our urological anomalies. Early diagnosis, immediate drainage and intensive medical care are important factors for better prognosis. Initial adequate drainage is more important that valve ablation, which can wait. Primary bilateral poor kidney function is a bad prognostic factor.

Presented at the: 11th Saudi Urology Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Ureteral approximation technique of gil-vernet in primary and posterior ureteral valve refluxes

N. Simforoosh1,2

1Department of Urology, Shahid Beheshti University of Medical Sciences, 2Department of Urology, Shahid Labbafi Nejad Medical Center, Tehran, IR Iran

Ureteral approximation technique of Gil-Vernet was done in 56 children with 90 refluxing ureters (34 bilateral, 22 unilateral). 43 patients had primary reflux due to posterior urethral valve (PUV) which persisted after ablation. Average age of patients were 5.8 years. 53% of the children had grade IV or V ureteral reflux postoperatively.

Average postoperative follow up time was 31 months (3-82 months) 14 patients had more than 4 years follow up. Reflux stopped in 91% of refluxing ureters. Postoperative ureteral obstruction was not seen.

Ureteral approximation techniques is a simple, safe and effective method to correct vescoureteral reflux which can decrease morbidity, operative time and hospitalization. It can be effective performed in high grade refluxes with a history of PUV ablation.

Presented at the: 11th Saudi Urology Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Prognostic factors in Saudi children with posterior urethral valves

V. C. Onoura, A. H. Meabed, A. H. Koko, M. A. Turki, N. Al Jawini, K. Mirza

Department of Urology, Riyadh Medical Complex, Riyadh, Saudi Arabia

Posterior urethral valves (PUV) account for a sizeable proportion of children with chronic renal failure. Several criteria have been identified as predictive of future renal function in children with PUV. We compared the presenting features and initial treatment in two groups of Saudi children treated of PUV with the purpose of identifying any factors that might account for the differences observed in their ultimate renal function. One group (Group A, 19 patients) had normal serum creatinine at follow up and the other (Group B, 13 patients) had elevated levels. There was no significant difference in age or weight at presentation, incidence and severity of reflux, urinary tract infection, or type of primary treatment (valve ablation versus vesicostomy) between the two groups.

However, after a period of catheter drainage, the mean serum creatinine level was 88.20 + 62.05 mmol/L for patients in group A as against 172.42 + 76.60 mmol/L for those in group B (p < 0.0001). In addition, the mean percentage drop in serum creatinine was 62.75 + 21.78 and 27.67 + 35.67 in groups A and B, respectively (p = 0.0016). These difference were highly significant. Linear regression analysis of post drainage creatinine and serum creatinine at least follow up showed a correlation coefficient of 0.7171 (p < 0.0001) while that of percentage creatinine drop and creatinine at follow up revealed a coefficient of 0.5962 (p = 0.0003). Our results showed that serum creatinine level after a period of catheter drainage as well as the percentage drop in serum creatinine correlated strongly with renal function at long term follow up in Saudi children with PUV. This finding might help in the selection of optimal initial therapy and provide some basis for prognostication.

Presented at the: 12th Saudi Urology Conference Al Hada and Taif Armed Forces Hospitals Program 23-25 February 1999 (7-9 Dhu Al Qa’dah 1419)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Presentation of posterior urethral valves in Saudi Arabia

K. F. Neel, S. R. El Faqih

Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Introduction: The mode and timing of presentation of patients with posterior urethral valves have been shown to significantly affect the outcome of those patients in the future. Here we review the presentation of posterior urethral valve to a referral hospital in Saudi Arabia and what are the difference between the mode of presentation of (PUV) between Saudi patients and patients in developed countries.

Materials and Methods: 35 patients were seen in the Urology/Pediatric Urology unit in King Khalid University Hospital. We reviewed them in regard to age at first presentation, mode of presentation, renal ultrasound at presentation, renal function at presentation and upon follow up and renal scan at presentation.

Results: Of the 35 patients, 10 (28.5%) presented with antenatal diagnosis, 6 (17%) between the age of 7 days and 3 months, 4 (11.5%) between the age of 3 months and 1 years and 15 (43%) above the age of one year. The mode of presentation was antenatal diagnosis in 10 patients (28.5), retention of urine in neonatal life 1 (3%), parents noticed poor urinary stream 14 (40%) and 10 (28.5%) patients presented with urinary tract infection. The first ultrasound done showed 53 (76%) renal units having moderate to severe hydronephrosis. Their first renal scan showed moderate of 44 renal units (63%) with reduced or no function. And at presentation 19 (55%) patients had renal impairment and this continued in 15 (43%) patients.

Discussion: Despite the great advances in antenatal diagnosis and the availability of antenatal ultrasound, this was not reflected on the presentation of our patients with PUV, 71.5% of our patients were not diagnosed antenatally despite the presence of moderate to severe hydronephrosis in 76% f the renal units at presentation. The way the antenatal management and the interpretation of antenatal ultrasound should be reviewed in order to reduce the incidence of missed urogenital anomalies, which is one of the main indications of antenatal ultrasound, so proper early management can be done.

Presented at the: 12th Saudi Urology Conference Al Hada and Taif Armed Forces Hospitals Program 23-25 February 1999 (7-9 Dhu Al Qa’dah 1419)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Primary ablation of posterior urethral valves in low birth weight neonates by a visually guided fogarty embolectomy catheter

Sherif Mahmoud Soliman

Division of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Objective: In the low birth weight neonate, primary ablation of a Posterior Urethral Valves (PUV) represents a particular difficulty. The small caliber of the urethra hardly accommodates the smallest commercially available pediatric resectoscope. Apart from delayed ablation after a period of vesicostomy, alternatives for primary ablation include

  • Bug bee or Laser fiber ablation via a neonatal cystoscope which is not free from intense difficulty in precisely manipulating the ablating instrument in the narrow field

  • “Foggy” ablation by a Fogarty embolectomy catheter under radiological surveillance, and

  • Antegrade visual ablation by the suprapubic route.

Herein, we present an alternative hybrid method for primary valve ablation in this difficult subset of patients utilizing a Fogarty embolectomy catheter working retrogradely under direct visual guidance.

Patients and Methods: Under general anesthesia, five newborn boys with established diagnosis of PUV (weight range 1900-2650 gms, median 2300) underwent primary valve ablation utilizing a 2F Fogarty embolectomy catheter passed through a 7.5F neonatal cystoscope with an offset lens (Storz®). An 8F Nelaton catheter was left indwelling for 48-72 hours after the procedure. Age range at procedure was 8-42 days (median 18 days). All patients had an antenatal diagnosis of hydronephrosis (4 bilateral, and 1 unilateral), three had bilateral vesicoureteric reflux (VUR) of grade IV-V, while one with unilateral VUR grade V with intrarenal reflux and VURD syndrome and urinary ascites. Follow up included a voiding cystourethrogram and an ultrasound examination 8-10 weeks after the procedure.

Results: There were no immediate perioperative complications. Follow up voiding cystourethrography showed effective relief of obstruction and good drainage with decompression of the posterior urethra in all patients. Of the 4 refluxers, VUR had disappeared in one, downgraded to grade II and III in two and remained unchanged in the one with VURD syndrome.

Conclusion: Utilization of visually guided Fogarty embolectomy catheter primary valve ablation in low birth weight neonates ensures direct retrograde disruption of the valvular obstructive mechanism in a precise and relatively easy manner, away from risking damage to the vulnerable small urethra of this subset of patients. We believe that it is more precise than using the catheter under radiographic control, and it avoids the annoyances of precise placement of bug bee or laser fibers on valve leaflets when passed through a small scope with a narrow field, meanwhile the retrograde passage per urethra avoids disturbing the bladder contrary to the other options of vesicostomy with delayed ablation, or suprapubic primary ablation.

Presented at the: 18th Saudi Urological Conference King Abdulaziz University Hospital 20-23 February 2006 (21-24 Muharram 1427)

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Early anticholinergic medication after valve ablation in valve bladder patient: Can it have a prophylactic effect against valve bladder?

M. Salem, K. Fouda, S. M. Soliman, Amenah Khatab

Department of Surgery, Division of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Aim of the Study: The valve bladder syndrome is a well known entity and identified in patients with posterior urethral valve and persistent upper tract dilatation following valve ablation, including a non-compliant thick walled bladder bilateral hydronephrosis and urinary incontinence. Here, we evaluate the effect of early anticholinergic medication after valve ablation on the upper tract.

Materials and Methods: We retrospectively reviewed the records of all patients diagnosed with PUV in the first year of life and had evidence of valve bladder manifested by upper tract dilatation were started on anticholinergic medications early post fulguration.

Results: Total of 23 patients were included in our protocol, all had primary valve ablation with evidence of valve bladder manifested by upper tract dilatation. Out of the 23 patients (46 renal units) 22 (47.8%) renal units showed resolution or downgraded of hydronephrosis, 18 (39%) showed no change and 6 (13%) showed deterioration of degree of hydronephrosis.

Conclusion:

  • Treatment of posterior urethral valve remains a clinical challenge requiring active management from infancy into adulthood to avoid progressive bladder dysfunction and deterioration of both upper and lower urinary tract, early diagnosis and fulguration followed with anticholinergics may improve prognosis of valve patients

  • Although this result is promising but still need to be documented with large randomized prospective study.

Presented at the: 19th Saudi Urological Conference King Khalid University Hospital – Riyadh 26 February – 01 March 2007

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Posterior urethral valves: An experience from madinah al monawara, Saudi Arabia

Hamza Alsisi, Tariq I Hummaida, Howaida Idresi, Ramzea Safar

Department of Surgery, King Fahad Hospital, Al Baha, Department of Pediatric Surgery, Madinah Maternity and Children Hospital, Madinah Al Monawara, Saudi Arabia

Thirty two patients with posterior urethral valves, managed in Pediatric Surgery Department, Madina Maternity and Children Hospital and Urology Department, King Fahad Hospital, Madinah Al Monawara in the period 1994–2001 were reviewed. Eighty percent of the patients were less than one year old. The diagnosis was established by voiding cystourethrogram and confirmed by cystoscopy. Satisfactory outcome was seen in 11 of the 14 patients treated by primary transurethral valve ablation without the need for any further treatment. Cutaneous vesicostomy followed by valve ablation was performed in 18 patients. Vesicoureteric reflux occurred in 22 (68.8%) of cases, in seven cases unilateral reimplantation of the ureter was needed while only three needed bilateral reimplantation. Nephroureterectomy was performed in four patients.

Presented at the: 19th Saudi Urological Conference King Khalid University Hospital – Riyadh 26 February – 01 March 2007

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Fate of VUR associated with PUV: A single centre experience

A. Gomha, K. Fouda, M. Salem, A. Shaheen, S. Soliman, H. Alhazmi

Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Aim of the Work: To review the outcome of VUR associated with PUV post ablation.

Patients and Methods: Files of the patients with PUV that had their initial treatment by ablation at KKUH since 2000 were reviewed. Age, serum creatinine, hydronephrosis and degree VUR at first presentation were collected and analyzed. These data were compared with the postoperative degree of VUR.

Results: During this period out of the 43 treated patients, 27 were diagnosed to have VUR (46 renal units; 8 patients had unilateral reflux). 16 patients had a follow up MCUG and were ready for evaluation (28 renal units, 4 patients with unilateral VUR). All patients were less than 4 years (mean 0.86 ± 14 months). Mean serum creatinine at diagnosis was 130 mmol/L (± 127 mmol/L). Hydronephrosis was detected in 93.75% of the renal units (30 units). High grade hydronephrosis (GIII and GIV) was in 55% out of that. High grade VUR (GIV and GV) was diagnosed in 75% of the renal units at presentation. All cases received post ablation anti-cholinergic medications. On evaluation of follow up MCUG, there was no upgrading of reflux. On the other hand, there is downgrading in 60.8% of the renal units. High grade reflux represented 31.25% only postoperatively of the renal units. Mean serum creatinine on follow up was 49.2 mmol/L (± 22.7 mmol/L).

Conclusion: Early endoscopic intervention for cases of posterior urethral valve can result in downgrading or resolution of the VUR in most of the patients.

Presented at the: 20th Saudi Urological Conference King Fahad Hospital of the University – Tabuk 18-20 March 2008

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Long term follow up of patients with posterior urethral valves: Experience from a tertiary center

A. Gomha, K. Fouda, H. Al Hazmi, M. Salem, F. Al Kawai

Department of Pediatric Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Objective: Analysis of the late outcome of patients with posterior urethral valves (PUV) managed at King Khalid University Hospital.

Patients and Methods: We retrospectively analyzed the outcome of patient with PUV managed at KKUH between 1998 and 2007. The mean follow up duration was 45.9–45.6 months. We divided children according to age at presentation into 3 groups: group I (in the neonatal period), group II (less than 1 year old) and group III (greater than 1 year old). Outcome evaluation included: serum creatinine, renal US, vesicoureteral reflux and need for surgical intervention. These data were correlated with age at management and the initial intervention.

Results: Seventy seven patients were diagnosed to have PUV at this period and managed at KKUH (28, 29 and 20 in group I, II and III, respectively). Primary valve ablation was the first intervention in 72 patients (93.5%). Vesicostomy was needed in the other 5 due to bladder instability. Of the 72 patients, anticholinergic (oxybutinin hydrochloride) was started immediately postoperatively in 59 patients (81.9%), and CIC was indicated immediately in 23 patients (31.9%). Mean serum creatinine after at least one year of follow up was 76.4 mM/L (compared to preoperative 97.5 mM/L). VUR disappeared or was downgraded in 22.9% of refluxing renal units. Twenty patients (28%) needed auxiliary surgical procedure in the form of endoscopic correction in 7 patients and reconstructive surgery in another 13 patients. Hydronephrosis improvement was 64.7%, 38.6% and 46.7% of the renal units in group I, II and III, respectively. Most of the patients who required reconstructive surgery were in groups II and III (5 in each group).

Conclusion: Early endoscopic correction of PUV is a simple procedure that can save patients from hazards of major reconstructive surgery. Early use of anticholinergic may improve the outcome with proper early management and follow up.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S109–S115.

Early posterior urethral valve ablation: A 20-year Seattle experience

Ahmad A. Elderwy, Thomas Lendvay, Michaela Pisani, Byron Joyner, Michael Mitchell, Richard Grady

Department of Pediatric Urology, Assiut University Hospital, Assiut, Egypt

Introduction: We hypothesize that early valve ablation (EVA) of posterior urethral valves (PUV) is associated with improved bladder and renal function.

Methods: IRB approval was obtained to review the charts of 160 consecutive PUV cases treated at our hospital between 1985 and 2005. Seventy-six patients were identified as having undergone PUV treatment within 10 months of birth and had a minimum follow up of 5 years. Treatment compromised of EVA in 51 patients (group 1) and urinary diversion (UD) in 25 (group 2). Recovery of bladder and renal function as well as resolution of vesicoureteral reflux (VUR) and hydronephrosis (HN) within the 2 treatment groups was compared. In addition, the groups were then sub-stratified to patients with a post-interventional glomerular filtration rate (GFR) nadir & #8805; or < 60 ml/min/1.73 m2.

Results: Eighty-eight percent of patients were < 3 months old at diagnosis with a median follow up of 12 years, range 5 to 21 years. No significant difference was present between the two groups regarding age at presentation, presenting symptoms, VUR, and HN. A higher proportion of children in Group 1 achieved complete toilet training compared to Group 2 (71% vs. 48%, p = 0.025). Spontaneous resolution of VUR significantly increased in the EVA group (41% vs. 10%, p-0.008). Moreover, spontaneous resolution of HN was more evident with EVA compared to UD (67% vs. 40%, p = 0.032). There was no statistically significant difference between EVA and UD in regards to both the incidence and timing of end stage renal disease within GFR subgroups (Log-rank test: p = 0.102).

Summary and Conclusion: While EVA is as effective as urinary diversion at preserving renal function, it offers a significant potential for recovery of bladder function and spontaneous resolution of VUR and HN on long-term follow up. Therefore, EVA should be used as a definitive treatment for PUVs.

Presented at the: 22nd Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 15-18 March 2010

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