Outcome of Late Presentation of Posterior Urethral Valves in a Resource-Limited Economy: Challenges in Management

Delayed presentation of patients with posterior urethral valve with complications like severe urosepsis, uremia, and anemia are seen in our setting. Renal replacement therapy which should have been offered to these patients is not readily available for children in our country. The aim of this study is to determine the pattern of late presentation and outcome of management of posterior urethral valve in a resource-limited setting. A descriptive retrospective study (1997–2009) was conducted. Data including pattern of presentation, duration of symptoms, complications, and outcome of initial management were analyzed. Twenty-one patients were seen. The median age was 3 years (2 days–13 years). The mean duration of symptoms before presentation was 2.6 years. Nineteen patients (91%) presented with urosepsis while 8 patients (36%) presented with significant renal insufficiency. Laboratory findings varied from-mild-to marked elevation in serum creatinine. Radiological findings confirmed the diagnosis of posterior urethral valve. We concluded that late presentation is common in our setting. This is associated with high morbidity and mortality rates. Efforts at improving awareness and early diagnosis among the health team should be made to stem the tide.

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Clinical and Radiological Changes after use of Alpha-1 Blocker Therapy in Patients of Posterior Urethral Valve with Bladder Neck Hypertrophy

JMS SKIMS ◽

10.33883/jms.v12i1.7 ◽

2009 ◽

Vol 12 (1) ◽

pp. 3-7

Author(s):

Aejaz A Baba ◽

Bajpai Minu

Keyword(s):

Bladder Neck ◽

Posterior Urethral Valve ◽

Posterior Urethral Valves ◽

Blocker Therapy ◽

Urethral Valve ◽

Novel Method ◽

Radiological Changes ◽

Group 2 ◽

Mean Time ◽

Group 1

Background: We evaluated the effects of alpha-1 blocker therapy on clinical and radiological abnormalities in patients of posterior urethral valve with bladder neck hypertrophy. Materials and Methods: A total of 74 patients with posterior urethral valves were seen at our department between 2003 and 2007. Out of these 24 had radiological evidence of bladder neck hypertrophy. Those patients with bladder neck hypertrophy who were seen before June 2006 and did not receive alpha-1 blocker (prazocin) therapy after valve ablation were assigned to group 1 (n=10). Group 2 consisted of 14 age matched patients with bladder neck hypertrophy and comparable prognostic factors who received alpha-1 blocker therapy after valve ablation (n=14). Micturating cystourethrography (MCU) was done periodically and a novel method used to calculate bladder neck hypertrophy. Trends in symptoms and radiological changes were evaluated throughout follow-up. Results: Mean patient age at presentation was 3.02±2.68 years in group 1 and 3.12±3.4 years in group 2. Bladder neck hypertrophy decreased from 2.3±1.0 to 2.0±0.5 in a mean time of 52.0 (34-52) weeks in group 1 where as it decreased from 2.2±0.5 to 1.6±0.3 in a mean time of 32.0 (22-52) weeks. Symptomatically patients in group 2 who received alpha-1 blocker therapy after valve ablation were better and had quick resolution of bladder neck hypertrophy. Conclusions: Use of alpha-1 blocker therapy in patients of posterior urethral valve with bladder neck hypertrophy helps in quick resolution of bladder neck hypertrophy. J Med Sci 2009;12(1):3-7.

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Late presentation of posterior urethral valve: two case reports

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000200012 ◽

2008 ◽

Vol 126 (2) ◽

pp. 126-127 ◽

Cited By ~ 4

Author(s):

Carlos Márcio Nóbrega de Jesus ◽

José Carlos de Souza Trindade Filho ◽

José Goldberg

Keyword(s):

Urinary Tract Infection ◽

Case Report ◽

Case Reports ◽

Clinical Signs ◽

Posterior Urethral Valve ◽

Late Presentation ◽

The Other ◽

Voiding Cystourethrography ◽

Urethral Valve

CONTEXT: Posterior urethral valve (PUV) is a widely known condition affecting males that generally presents prenatally or at birth. PUVs have also been occasionally described in literature in cases diagnosed during adolescence or adulthood. CASE REPORT: This report presents two late PUV cases, one in a teenager and the other in an adult. Both cases had had clinical signs of urinary tract infection and obstructive urinary symptoms. The diagnoses were made by means of voiding cystourethrography and urethrocystoscopy. Endoscopic valve fulguration was the treatment chosen for both. Their follow-up was uneventful.

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A rare clinical finding of posterior urethral valve: Recurrent epididymo-orchitis

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2020.71676 ◽

2020 ◽

Author(s):

Serdar Mollaoğlu ◽

Sırma Mine Tilev ◽

Okyav Bosnalı ◽

Ayşenur Celayir

Keyword(s):

Clinical Finding ◽

Rare Condition ◽

Posterior Urethral Valve ◽

Posterior Urethral Valves ◽

Diagnosis And Treatment ◽

Urinary System ◽

Urethral Valves ◽

Urethral Valve

Recurrent epididymo-orchitis is a rare condition in children. Considering that obstructive infravesical pathologies, such as posterior urethral valves, may cause recurring epididymo-orchitis in children, a thorough examination of the genito-urinary system will prove essential for the diagnosis and treatment of the main pathology. We herein present a case of posterior urethral valve presenting with recurrent episodes of epididymo-orchitis.

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Spontaneous bladder rupture secondary to posterior urethral valves in a boy with Down syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-240857 ◽

2021 ◽

Vol 14 (9) ◽

pp. e240857

Author(s):

Massimo Garriboli ◽

Shimaa Ibrahim ◽

Joanna Clothier

Keyword(s):

Down Syndrome ◽

Posterior Urethral Valve ◽

Posterior Urethral Valves ◽

Bladder Rupture ◽

Suprapubic Catheter ◽

Spontaneous Bladder Rupture ◽

History Of ◽

Urethral Valve ◽

Tract Infections ◽

Incomplete Bladder Emptying

We describe a case of a 3-year-old boy with Down syndrome who developed a bladder rupture as a consequence of an undiagnosed posterior urethral valve (PUV). He had a history of urinary tract infections and constipation and was acutely admitted in poor condition and underwent laparotomy that revealed peritoneal sepsis secondary to bladder perforation. Bladder was drained using a suprapubic catheter and the condition of the boy gradually improved. Once stable, a cystourethroscopy confirmed the presence of PUV. Video-urodynamic studies performed at the check cystoscopy showed the bladder to be of reduced compliance (end fill pressure at 100 mL fill 30 cmH2O) with raised voiding pressures (76–100 cmH2O) and significant incomplete bladder emptying. Currently, the patient is doing very well, serum creatinine has normalised, he is infection-free and thriving; his bladder is managed with a vesicostomy.

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Delayed Presentation of Urethral Valves: A Diagnosis That Should Be Suspected Despite a Normal Prenatal Ultrasound

Global Pediatric Health ◽

10.1177/2333794x20958918 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2095891

Author(s):

Lisa B. E. Shields ◽

Jeffrey T. White ◽

Ahmad Z. Mohamed ◽

Dennis S. Peppas ◽

Eran Rosenberg

Keyword(s):

Renal Function ◽

Delayed Diagnosis ◽

Posterior Urethral Valves ◽

Prenatal Ultrasound ◽

Urethral Obstruction ◽

Delayed Presentation ◽

Urethral Valves ◽

Micturating Cystourethrogram ◽

Urethral Valve ◽

Anterior Urethral Valves

Background. Congenital urethral obstruction occurs most frequently as a result of urethral valves. The diagnosis is usually confirmed pre- or neonatally. Though not ideal, delayed diagnosis can occur in childhood, adolescence, or adulthood. Despite a normal prenatal ultrasound, there may still be a delayed diagnosis of urethral valves. Methods. We present 4 patients with delayed diagnosis of posterior urethral valves (PUV) and 1 patient with delayed diagnosis of anterior urethral valves (AUV) who were evaluated by a pediatric urologist at our Institution. We determined the age and symptoms at presentation, physical examination, micturating cystourethrogram (MCU) findings prior to the valve ablation, renal function before and after valve ablation, type of valve ablation, and urine culture and sensitivity. The urological courses following urethral valve ablation including urodynamic study findings are described. Results. The median age at presentation was 33 months. All 5 patients presented with decreased urine output and urinary retention. All 5 patients underwent a MCU that demonstrated bladder trabeculations (3 cases), vesicoureteral reflux (3 cases), and bladder diverticula (2 cases). A urethral valve ablation was performed in all cases. Four patients underwent a renal function panel prior to this procedure, and their serum BUN/creatinine levels decreased 1 day postoperatively. Conclusion. Pediatricians should consider urethral valves as causing urethral obstruction although the prenatal ultrasound may be normal. Early diagnosis and prompt treatment of urethral valves may mitigate the potentially devastating morbidities such as renal failure, congestive heart failure, and respiratory distress that may ensue.

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Infant Bladder Rhabdomyosarcoma in a Shared-Care Centre in Ghana: Case Report and Review of the Literature

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i05/1122 ◽

2021 ◽

Vol 6 (05) ◽

pp. 351-355

Author(s):

Edwin M.T. Yenli ◽

Kingsley A Bimpong ◽

Nihad Salifu ◽

Peter G. Kwarteng ◽

Ernest K. Cheyuo ◽

...

Keyword(s):

Digital Rectal Examination ◽

Pelvic Mass ◽

Posterior Urethral Valve ◽

Paediatric Oncology ◽

West African ◽

Resource Limited ◽

Daunting Task ◽

Urethral Valve ◽

Abdominal Examination ◽

Study Setting

Rhabdomyosarcoma is a fairly common soft tissue sarcoma among children. Genitourinary rhabdomyosarcoma accounts for one tenth of rhabdomyosarcomas in the West African sub-region. However, its occurrence and management are yet to be reported in our resource limited study setting. Care of such patients could be a daunting task. A comprehensive paediatric oncology service should be advocated to optimize the chances of survival. A seven-month old boy was referred to our facility on account of posterior urethral valve. A week’s complaint of crying on micturition, with associated passage of scanty urine and irritability, although he was apparently well since birth with no urinary complaints. A suprapubic mass was palpated on abdominal examination. Digital rectal examination revealed a nodular pelvic mass. Open cystostomy done and histopathology showed embryonal rhabdomyosarcoma of the urinary bladder. Chemotherapy was commenced on a modified Malignant Mesenchymal Tumour protocol of the International Society of Paediatric Oncology group. The mass was reduced by a third after six cycles of chemotherapy. In resource limited settings, the management of paediatric genitourinary rhabdomyosarcoma, using multidisciplinary and multimodal approach to include the hub for comprehensive paediatric oncology services should be advocated to optimize chances of survival.

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Late Presentation of Posterior Urethral Valve in a 24-Year-old Man

International Journal of Case Reports ◽

10.28933/ijcr-2019-03-2005 ◽

2019 ◽

Keyword(s):

Posterior Urethral Valve ◽

Late Presentation ◽

Urethral Valve

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Posterior Urethral Valve: Delayed Presentation in Adolescence

International Neurourology Journal ◽

10.5213/inj.2012.16.3.149 ◽

2012 ◽

Vol 16 (3) ◽

pp. 149 ◽

Cited By ~ 3

Author(s):

Punit Mahadik ◽

Surya Prakash Vaddi ◽

Chandra-Mohan Godala ◽

Venkatkrishna Sambar ◽

Sushanth Kulkarni ◽

...

Keyword(s):

Posterior Urethral Valve ◽

Delayed Presentation ◽

Urethral Valve

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PRESENTATION, MANAGEMENT, AND OUTCOME OF POSTERIOR URETHRAL VALVES IN WESTERN RAJASTHAN

10.36106/ijsr/0205504 ◽

2021 ◽

pp. 1-3

Author(s):

Naresh Sapariya ◽

Sugam Godse ◽

Gordhan Chaudhary ◽

M.K. Chhabra

Keyword(s):

Outlet Obstruction ◽

Posterior Urethral Valve ◽

Posterior Urethral Valves ◽

Creatinine Concentration ◽

Abdominal Sonography ◽

Long Term Follow Up ◽

Urethral Valve ◽

Posterior Urethra

Introduction: Posterior urethral valve (PUV) is the most common cause of bladder outlet obstruction and renal insufciency in male children. The aim of this study was to evaluate the presentation, management, challenges, and outcome of the disease in a Western Rajasthan tertiary health institution. Methods: In a retro-prospective study, 26 male children were included from November 2017 to March 2020 at Dr. S.N.Medical college, Jodhpur. Diagnosis was conrmed by voiding cysto-urethrography (VCUG). Results: A total of 26 patients were managed for PUV.The mean age of presentation was 3.45 years with 65.8% of the patients presenting after 1 year. Voiding dysfunction noted in 23(88.4%) patients was the most common presentation. Most common nding on physical examination was palpable bladder 15(57.6%) while UTI noted in 15 (57.6%) patients was most common complication. Abdominal sonography revealed dilated posterior urethra in 10(38.4%) cases, while VCUG revealed a dilated posterior urethra in 19 (75%) cases.The creatinine value at presentation ranged from 0.4-4.5 mg/dl with a mean of 1.10 ± 0.95 mg/dl. Valve ablation with a diathermy bugbee electrode & holmium laser provided relief of obstructions in the 23 (88.4%) patients who underwent the procedure without immediate complication. The period of follow-up ranged between 1 weeks to 2 years with a mean of 8.2 months. There was sustained improvement in urine stream, reduction in the mean creatinine concentration and incidence of UTI during follow-up. Conclusion: Many patients with PUVpresented late within the reviewed period. Valve ablation provided relief of obstruction in most of the cases. Efforts at improving awareness among general population and early diagnosis and referral among the health team should be encouraged. There is a need to counsel parents on the need for long-term follow-up

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