Challenges of Management of Posterior Urethral Valves: Case Series.

Abstract

Introduction: Posterior urethral valve (PUV) is the commonest cause of bladder outlet obstruction in children. Neonate may present with obstructive nephropathy. Some children may present with subtle symptoms or bladder stones. The presentation, voiding cystogram and endoscopic findings may be atypical. There may be challenges in performing micturating cystogram in infants. Atypical findings, choice urinary diversion, appropriate pediatric endoscope and approach for stone removal may poise management challenge. Objective: to present case series of posterior urethral valves with management challenges. Case series: We present case series of 15 posterior urethral valves with various management challenges ranging from diagnostic to therapeutic. Infants with obstructive nephropathy had initial vesicostomy before confirmation using voiding cystogram and endoscopy. Endoscopic valve ablation or incision were done when the children became older. Older symptomatic children or those with initial presentation with bladder stone had voiding cystogram for detection of PUV which if the findings were not typical, the appropriate diagnosis was made endoscopically. Patients with large burden of stone had cystolithotomy after the valve ablation or incision. Conclusion: The challenges of the management of PUV can be diagnostic or therapeutic. Children with obstructive nephropathy had vesicostomy and then cystogram before endoscopic management. The accurate diagnosis may be done only after the endoscopy. Patients with large burden of stone can be tackled easily using open cystolithotomy.