Abstract
Posterior urethral valve (PUV) obstruction is the most common cause of bladder outlet obstruction in boys. Currently, the diagnosis of PUV is commonly made prenatally. In our environment, however, prenatal diagnosis is rare and the diagnosis is usually made postnatally from the clinical and radiological features. This study therefore examines the clinical and radiological spectrum of boys with PUV in our environment. We examined the clinical presentations, ultrasonographic and the micturating cystourethrographic (MCUG) features of boys with PUV in our institution over a 22-month period from June 2006. There were 28 patients with PUV over this period. The age at presentation ranged from 11 days to 11 years (mean age = 2.7 years). Although prenatal ultrasound scan was done in 23 (82.1%) patients, no prenatal diagnosis was made in any of the patients. The diagnosis was made after infancy in 16 (57.1%) patients. Recurrent urinary tract infection (UTI) was the most common mode of presentation occurring in 14 (50.0%) patients with 7 (50.0%) of the patients with UTI presenting with septicaemia. Voiding dysfunctions, which occurred in all the patients, were the primary mode of presentation in 12 (42.9%) patients. Three (10.7%) patients presented with renal insufficiency, which was significantly associated with the age at presentation (P = 0.026). Ultrasound scan done in the postnatal period strongly suggested the diagnosis of posterior urethral valves in 22 (78.6%) patients in whom the posterior urethra was found to be dilated, associated with thick-walled urinary bladder and bilateral hydronephrosis. Trabeculations of the bladder was a constant feature on MCUG. Other features on MCUG included dilatation of the posterior urethra in 26 (92.8%), bladder diverticuli in 15 (53.6%) and unilateral and bilateral vesicoureteric reflux in 3 (10.7%) and 1 (3.6%) patient(s), respectively. The diagnosis of PUV obstruction which is often made late in our environment, is mainly by clinical, sonographic and MCUG features in the postnatal period. A majority of patients present late, with recurrent UTI.
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References
Dewan PA, Zappala SM, Ransley PG, Duffy PG (1992) Endoscopic reappraisal of the morphology of congenital obstruction of the posterior urethra. Br J Urol 70(4):439–444
Imaji R, Dewan PA (2001) The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction. BJU Int 88(3):263–267
Casale AJ (1990) Early ureteral surgery for posterior urethral valves. Urol Clin North Am 17(2):361–372
Parkhouse HF, Barratt TM, Dillon MJ, Duffy PG, Fay J, Ransley PG, Woodhouse CR, Williams DI (1988) Long-term outcome of boys with posterior urethral valves. Br J Urol 62(1):59–62
Reinberg Y, de Castano I, Gonzalez R (1992) Influence of initial therapy on progression of renal failure and body growth in children with posterior urethral valves. J Urol 148(2 Pt 2):532–533
Tejani A, Butt K, Glassberg K, Price A, Gurumurthy K (1986) Predictors of eventual end stage renal disease in children with posterior urethral valves. J Urol 136(4):857–860
Tietjen DN, Gloor JM, Husmann DA (1997) Proximal urinary diversion in the management of posterior urethral valves: is it necessary? J Urol 158(3 Pt 2):1008–1010
Lissauer D, Morris RK, Kilby MD (2007) Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med 12(6):464–470
Ugwu AC, Ahamefule K, Egwu OA, Otu E, Okonkwo CA, Okafor LC (2007) Patient satisfaction with obstetric ultrasonography. Radiol Technol 79(2):113–118
Shittu OB, Asinobi AO (2004) Long-term outcome of posterior urethral valves ablation using the Mohan’s urethral valvotome. West Afr J Med 23(1):35–37
Asinobi AO, Gbadegesin RA, Shittu OB (2004) A review of cases of posterior urethral valves seen at the University College Hospital, Ibadan (Nigeria). Pediatr Med Chir 26(6):430–433
Abraham MK (1990) Mohan’s urethral valvotome: a new instrument. J Urol 144(5):1196–1198
Anochie I, Eke F (2004) Obstructive uropathy in childhood, as seen in University of Port Harcourt Teaching Hospital, Nigeria. Niger J Med 13(2):136–139
Dewan PA (1994) Antenatal diagnosis of posterior urethral valves. Br J Urol 73(5):600–601
Dinneen MD, Duffy PG (1996) Posterior urethral valves. Br J Urol 78(2):275–281
Hendren WH (1971) Posterior urethral valves in boys. A broad clinical spectrum. J Urol 106(2):298–307
Parkhouse HF, Woodhouse CR (1990) Long-term status of patients with posterior urethral valves. Urol Clin North Am 17(2):373–378
Ziylan O, Oktar T, Ander H, Korgali E, Rodoplu H, Kocak T (2006) The impact of late presentation of posterior urethral valves on bladder and renal function. J Urol 175(5):1894–1897 (discussion 1897)
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Ikuerowo, S.O., Balogun, B.O., Akintomide, T.E. et al. Clinical and radiological characteristics of Nigerian boys with posterior urethral valves. Pediatr Surg Int 24, 825–829 (2008). https://doi.org/10.1007/s00383-008-2163-3
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DOI: https://doi.org/10.1007/s00383-008-2163-3