Comparison of clinical course of patients with both posterior and anterior urethral valves vs those with anterior urethral valve alone

Abstract

To compare the clinical course of patients with concomitant posterior urethral valve (PUV) and anterior urethral valve (AUV) vs those with AUV alone, to know if associated PUV increases morbidity. Retrospective review of 24 AUV patients (2002-2018). Results were compared between boys with both PUV and AUV (Group A) vs AUV alone (Group B). Symptoms started from birth (n=6)/2 mths age (n=1) [group A]; birth (n=10)/2 mths–9 yr age (median 1 yr 3 mo) (n=7) [group B]. Most common symptom: poor urinary stream, dribbling. Age at presentation to us: 11dy-12yrs with blood Urea (mg/dL) A: 17-194 (median 23), B: 11-108 (median 23) Creatinine (mg/dL): A: 0.38-13.6 (median 0.7), B: 0.2 – 2.2 (median 0.65). Previously undergone circumcision (n=1), urethral dilatation (n=2), internal urethrotomy (n=1), PUV fulguration (n=2). Urethral diverticulum present in A: 4 (57.1%), B: 9 (52.9%). Valve location: between Bulbar/proximal penile urethra junction, Proximal/mid-penile urethra junction & Distal penile urethra: A: 4 (57.1%),3 (42.9%), 0 and B: 9 (52.9%), 1 (5.9%), 7 (41.2%) respectively. Renal function [nuclear scan] showed bilateral normal, bilateral impaired, unilateral non/ poorly functioning A: 4 (57.1% with bil slow drainage in 2), 2 (28.6%), 1 (14.3%) and B: 10 [58.9% with bil VUR (1),L II VUR(1)], 0, 7 (41.2%) respectively. Patients underwent fulguration and/or urethroplasty/diverticulum excision. Follow up: 6 mo-15 years. Total procedures specifically for valves 31 (average 1.4/patient) and overall 47 interventions (average 1.95/patient) including nephroureterectomy etc. Follow up: Although stream normalized in all, 3 required urinary diversion (A: n=2; B: n=1). Renal failure: A: 2 (28.6%), B: 1 (5.9%) (with associated urethral duplication) Bladder instability: A: 3 (42.9%), B: 6 (35.3%). Unless there is a visible swelling, there is a delay in diagnosis and referral to pediatric urologists in boys with AUV in spite of a majority being symptomatic since birth. Valve location in distal urethra is more common in isolated AUV. Patients with associated PUV presented earlier and had higher morbidity. All AUV patients need long term follow up.