Management of Posterior Urethral Valve in Male Child Population

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Management of Posterior Urethral Valve in Male Child Population

Journal Title: International Journal of Medical Research Professionals - Year 2018, Vol 4, Issue 4

Abstract

Introduction: The Posterior urethral valves remain the single most common urologic cause for renal failure and need for renal transplantation in children. These anomalies are unique to male children.PUVs are a common cause of lower urinary tract obstruction in male infants and the most common congenital cause of bilateral renal obstruction. Their incidence is estimated at 1/ 5,000 to 8,000 male births but they may in fact be more common due to fetal demise. Objective: To study the outcome following fulguration of Posterior urethral valve in male child population. Methods: From August 2004 and April 2007, in the present study, in a series of continuous 21 male child patients having posterior urethral valve were admitted in Department of Urology. All patients were well evaluated, followed-up and data analysis was done. Results: Our 21 patients ranging from 15 days to 12 years were treated by PUV fulguration age group from 1 month to 1 year.9 patients presented with voiding difficulty 5 patients with fever with voiding difficulty, 2 patients only with. One patient was incidentally detected and 4 patients in septicemia. Vesicostomy was done in 5 patients in periphery, supravesicle diversion needed in one. Following fulguration of PUV, serum creatinine become normal in 8, and 2 developed CRF there was improvement in hydronephrosis in 10 units, in grade of reflux in 8 units. In two units needed nephrectomy. Following PUV fulguration there was marked improvement in maximum flow rate and PVRV. UDS was interpreted as normal study in 2 of the 9 patients studied, unstable detrusor with small capacity bladder in 1 patient, unstable detrusor with normal capacity bladder 4 patients remaining 2 had hypocontractile bladder with normal capacity bladder. One patient had false passage during introduction of paediatric cystoscope, urethral catheter was kept for one week and then removed. One patient developed stricture at site of proximal bulbar region managed successfully endoscopically. Conclusions: Most of the patients of the PUV present during infancy with most common presentation are voiding difficulty having type-I PUV. Vesicostomy or supravesicle diversion should be considered in septicemic patients. Following PUV fulguration 80% of the patient achieve normal RFT and improvement in hydronephrosis, PVR and VU-reflexes around in 54.55%, in 85.71% and occurs in 35.71% respectively. Regular follow-up is must for all PUV patients. Persistent altered RFT and or VUR and or HN requires complete investigation including renal scan and urodynamic study.

Authors and Affiliations

Shailesh P. Bajaniya

Keywords

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EP ID EP535202
DOI 10.21276/ijmrp.2018.4.4.045
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