Diagnosis and management of late-presenting posterior urethral valves in children

Abstract

Objective The diagnosis of posterior urethral valve (PUV) is normally obtained before or after birth. However, sometimes it becomes delayed until childhood or even adolescence. Their clinical features and treatment outcomes have been rarely discussed. So we reported our experience of diagnosing and managing late-presenting PUV in children. Methods We searched for pediatric patients aged 2 to 14 years with late-presenting PUV treated between January 2010 and January 2017. Routine hepatorenal function tests, urinary tract ultrasound and excretory urography (VCUG) were performed. Clinical data were collected and clinical symptoms and imaging abnormalities were summarized. Results There were 26 pediatric patients with late-presenting PUV. Four of them were identified as lost to . The most common initial symptoms were recurrent urinary tract infection (n=10, 38.5%), inability of urinating (n=5, 19.2%), hematuria (n=5, 19.2%), odynuria (n=4, 15.4%), urinary frequency (n=4, 15.4%) and a history of enuresis (n=3, 11.5%). All of them underwent transurethral valve incision. And 2/22 follow-up cases had residual valve. Clinical symptoms improved in 40.9% of patients after surgical valular ablation. On ultrasound, patients with reduction of renal or urethral obstruction accounted for 38.5%. Conclusions PUV is not unique during infancy. VCUG is indicated early for voiding dysfunction in children, especially those with recurrent urinary tract infection and hematuria. Endoscopic valve incision is both feasible and efficacious with few postoperative complications. However, some patients persist with abnormal urination and other symptoms. Individualized treatment plans and long-term follow-ups are required. Key words: Urethra; Bladder; Hydronephrosis; Urinary incontinence; Posterior urethral valves