Congenital Posterior Urethral Valves

Jang, Kyung Jae; Yoon, Jong Byung

Abstract

A clinical observation was made on 5 cases of congenital posterior urethral valves admitted recently to the Department of Urology, Busan National University Hospital. The results were following: 1. Age distribution showed; 1 case (20%) under 6 months, 2 cases (40%) between 6 and 12 months, 2 cases (40%) over 6 years old. 2. The symptoms of urinary dribbling, weak stream, frequency and difficult urination were observed in all 5 cases. Abdominal mass, abdominal pain, fever, vomiting and failure to thrive were observed in 4 cases (80%) . Enuresis was observed in 2 cases (40%) . Hypertension and gross hematuria were observed in 1 case (20%) . 3. IVP revealed bilateral hydronephrosis and hydroureter in all cases. Vesicoureteral reflux was observed in 3 cases (60%) , in which 2 cases were unilateral and the other 1 case was bilateral and bladder diverticulum appeared in 3 cases (60%). Voiding cystourethrogram was performed on 4 cases, and in all of these 4 cases (100%) dilatation of posterior urethra and cut-off at the membranous level and a thin stream in the bulb and 2 cases (50%) bladder neck contracture due to congenital posterior urethral valves had developed. 4. Endoscopic examination was performed on 5 cases, in which 3 cases (60%) were young's type I, and remaining 2 cases 140%) were Young's type III. 5. All 5 cases were treated by transurethral electrofulguration of the valves and one case of them was performed bilateral ureteroneocystostomy 3 years after valve ablation but in the case with marked bilateral hydronephrosis and vesicoureteral reflux a cystostomy was also performed. 6. The follow up study was performed in 4 cases with the follow-up period from five months to 36 months and mean duration of 2 years. All 4 cases had excellent results with much improved urinary stream and Renal condition after operation, but in 2 cases intermittent incontinence occurred for 3 years and 1 year respectively. In all 4 cases much diminished hydronephrosis and urethral dilation on IVP were observed. The posterior urethral dilatation became nearly normalized and abnormal findings of bladder improved on voiding cystourethrogram, but in 2 cases with bladder diverticulum 1 showed nonspecific interval changes during 3 years and the other 5 months. In 2 cases with vesicoureteral reflux, 1 showed loss of vesicoureteral reflux spontaneously 1 month after the operation and the other showed persistent vesicoureteral reflux for 1 year, which was observed to be improving.