Double Urethral Valve: a Clinical Case

Introduction. Urethral valves (UVs) are congenital malformations of the urethra, leading to infravesical obstruction. The most common UV is the posterior urethral valve (PUV). The anterior urethral valve (AUV) is a somewhat rarer, but still well-known congenital anomaly. UVs can provoke significant obstruction of the proximal urinary system, which can later lead to disability of children and more frequent deaths.Materials and methods. The article presents a clinical example of a 32-year-old man with a congenital double urethral valve occuring in the anterior and posterior urethra, which led to the development of chronic urinary retention, urinary tract infection and chronic renal failure. The patient underwent a successful urethroplasty operation to remove the valve mechanism.Results. Six months following surgery, the patient noted the complete disappearance of symptoms, with renal function having returned to normal. No signs of recurrence of the disease or the formation of stricture of the urethra were detected by to the survey.Conclusion. A congenital variant of the double UV is an unusual extremely rare cause of infravesical obstruction. Early diagnosis and treatment of this anomaly is very important for preventing further irreversible damage to the urinary system. The presented clinical observation demonstrates the need to organise and conduct periodic preventive examinations of children of different age groups.

Symptomatic Male Urethral Diverticula- Presentation, Diagnosis and Management.

ABSTRACTObjective- To report our experience of aetiology, diagnosis, management and outcomes of uncommon male urethral diverticula managed at a single institute.Patients and Methods: After due approval from local ethical committee the case records of 8 male patients including a child presenting with urethral diverticula in a 10 year period (2002-2012) were retrospectively analysed with regard to presentation, diagnosis, management and outcomes.Results: A total of eight patients were identified having been managed for a urethral diverticulum during the period. Of the eight patients one was congenital diverticulum and rest acquired. A child aged 10 years, presented with straining to void and inability to empty the bladder and was diagnosed to have anterior urethral valve located at peno-scrotal junction. The valves were endoscopically resected and diverticulum de-roofed. The child recovered with good outcome of good flow and emptying of bladder. Patients with acquired diverticula, presented at a mean age of 42 years (25-60 years). The presentation was similar with two patients presenting with acute retention. The Aetiological factors included Trauma, Previous urethral surgeries like Visual internal urethrotomy and infection. The common site of diverticula was peno-scrotal junction, followed by distal penile urethra. Two patients were treated with primary excision and establishment of urethral continuity and rest with two stage procedures. The outcome was poor in one patient of primary excision who presented later with stricture at the anastamotic site.Conclusions: Unlike in female population, male urethral diverticula are uncommon but should always be thought of in young men with obstructive urinary symptoms and in those with a past history straddle injuries. Treatment if individualized leads to good outcomes.