Evaluation, management and follow up of vesicoureteric reflux in the setting of posterior urethral valve
Iranian Journal of Pediatric Surgery,
Vol. 8 No. 2 (2022),
Introduction: Posterior urethral valve represents the most common etiology of congenital urethral obstruction in boys. 35-50% of PUV cases have vesicoureteric reflux at the time of diagnosis. Endoscopic ablation of valves is the treatment of choice. In this study we evaluated the association of primary kidney function and VUR in patients with PUV and assessed the rate and timing of resolution of VUR after valve ablation.
Materials and Methods: A prospective, observational study was done in which children with VUR secondary to PUV were included. A clinical history was taken. Preoperative work up with complete blood picture, renal function tests, ultrasonography, voiding cystourethrogram was done. All patients underwent cystoscopy and fulguration of the posterior urethral valves. The patients were followed up with ultrasound, MCUG and DMSA scan. Resolution of VUR was studied.
Results: 56 patients were included in the study. 38 out of 56 cases had an antenatal history of HDN. Bilateral VUR was seen in 33 cases (59%). Unilateral VUR was seen in 23 cases. Each side of reflux was considered as an individual unit in bilateral cases.The total number of units was 89. Resolution of reflux was seen in 27 units. Downgrading of reflux was seen in 53 units. 9 units neither showed resolution nor downgrading.
Conclusion: VUR is the major cause of postnatal damage in PUV. Early resolution of reflux after valve ablation was seen in cases with low grade reflux. Resolution of reflux is more in cases with unilateral reflux than with bilateral reflux.
- Vesicoureteric reflux, posterior urethral valve, urinary tract infection, cystoscopic fulguration
How to Cite
Young HH, Frontz WA, Baldwin JC: Congenital obstruction of the posterior urethra. J Urol 1919; 3:289.
Johnson JH, Kulatilake AE: The sequelae of posterior urethral valve. Br J Uro 1971; 43: 743-748.
Smith GH, Duckett JW, Canning DA: Posterior urethral valve, a cohort with 20 years follow up. J Urol 1994; 8: 348.
Johnston JH: Vesicoureteric reflux with urethral valves. Br J Urol 1979; 51: 100.
Tejani A, Butt K, Glassberg K, et al: Predictors of eventual end stage renal disease in children with posterior urethral valves. J Urol 1986;136(4):857-60.
Parkhouse HF, Barratt TM, Dillon MJ, et al: Long-term outcome of boys with posterior urethral valves. Br J Urol. 1988;62(1):59-62.
Hodges SJ, Patel B, McLorie G, et al: Posterior urethral valves. The Scientific World JOURNAL 2009; 9:1119-26.
Macpherson R, Leithiser RE, Gordon L, et al: Posterior urethral valves: An update an review. Radiographics 1986; 6(5):753-791.
Scott JES: Management of congenital posterior urethral valve. Brit J Uro 1985,57:71-77.
Uthup S, Binitha R, Geetha S, et al: A follow-up study of children with posterior urethral valve. Indian journal of nephrology 2010;20(2):72.
Mirshemirani A, Khaleghnejad A, Rouzrokh M, et al: Posterior urethral valves; a single center experience. Iranian journal of pediatrics 2013;23(5):531-5.
Malik MA, Javed Sial SH, Iqbal Z, et al: Posterio urethral valves. Professional Med J 2005;12(4):473-8.
Sudarsanan B, Nasir AA, Puzhankara R, et al: Posterior urethral valves: a single center experience over 7 years. Pediatr Surg Int 2009;25(3):283-7.
Koff SA, Mutabagani KH, Jayanthi VR: The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. The Journal of urology 2002;167(1):291-7.
Hassan J, Pope JC, Brock JW, et al: Vesicoureteral reflux in patients with posterior urethral valves J Urol. 2003; 170:1677-1680.
Kajbafzadeh AM, Payabvash S, Karimian G: The effects of bladder neck incision on urodynamic abnormalities of children with posterior urethral valves. J Urol 2007; 178:2142-2149.
Bıçakcıa N, Dilek Demirelb B, Bıçakcıb U, et al: The long term renal and bladder function outcomes of patients with posterior urethral valve. Journal of Experimental & Clinical Medicine2020; 37(1): 11-16.
Assefa H, Getachew H, Tadesse A, et al: Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia. Research and Reports in Urology 2021;13.639-645.
Kabir M, Naz M, Al Farooq MA, et al: Outcome of prenatally diagnosed posterior urethral valve patients-experience from a low income country. Bangladesh Journal of Endosurgery 2013;1(3):20-3.
Gonzalez R, Reinberg Y, Burke B, et al:Early bladder outlet obstruction in fetal lambs induces renal dysplasia and the prune-belly syndrome. J Pediatr Surg 1990; 25:342-345.
Farrugia MK, Woolf AS, Fry CH, et al: Radiotelemetered Urodynamics of obstructed ovine fetal bladders: correlations with ex vivo cystometry and renal histopathology. BJU Int 2007; 99:1517-1522.
- Abstract Viewed: 52 times
- PDF Downloaded: 44 times