Challenges in the Management and Outcome of Posterior Urethral Valve in Aba, Nigeria

Abstract

Posterior urethral valves are the commonest cause of bladder outlet obstruction in boys. The incidence varies from 1 in 5000 to 25,000 live birth worldwide. The incidence in lower and middle- income countries is unknown due to paucity of data. . The aim of this study was to review the presentation, management and outcome of posterior urethral valve at the Abia State University Teaching Hospital Aba, Nigeria. Patients and Methods: Fifteen boys with posterior urethral valve seen at the Abia State University Teaching Hospital Aba from January 2016 to June 2018 were included in the study. Data collected includes demographic data, clinical features, and duration of symptoms, serum biochemistry, radiological diagnosis, surgical management and outcome. Results: The patient age ranged from 2 weeks to 2 years, Median age of 6 months. 7(46.6%) of the patients were neonates. The commonest symptoms were voiding dysfunction, distended bladder and anaemia. Duration of symptoms was 2weeks in 6 (40%) patients, 4 weeks in 4(27) patients and 8weeks in 5(33%) patients. 2(13%) patients had grade 2 vesicoureteric reflux on expressive cystourethrogram. All the patients had foley catheter avulsion of posterior urethral valve. There was no case of frank haemorrhage but haematuria was noticed which resolved spontaneously. Fourteen (93.3%) out of 15 patients reported consistent good urinary stream without evidence of renal deterioration. A patient (6.6%) had persistent straining at micturition requiring a repeat Foley catheter balloon avulsion. All mothers were satisfied with the outcome of treatment due to good post- operative urinary stream. There was complete resolution of the vesicoureteric reflux at 6 months post valve ablation expressive cystourethrogram. The post -operative urinary stream, serum electrolyte, and urea and cretinine status remained normal during follow up period of 6 months. Conclusion: Posterior urethral valve is a common cause of bladder outlet obstruction in boys, high index of suspicion will lead to early diagnosis, late presentation still persist due to poor knowledge of health care workers in our environment.