Abstract
Premature newborns with posterior urethral valves (PUV) may present with medical conditions taking priority over definitive surgical care. We encountered three of such cases who underwent initial bladder decompression via transurethral catheterization and waited 2–3 weeks until they were fit enough for voiding cysto-urethrography to confirm PUV. An unexpected good urinary flow and negligible residual urine volume were documented during micturition, suggestive of valve disruption induced by insertion and prolonged duration of indwelling urethral catheter drainage. Cystoscopy documented non-obstructing remnant leaflets. Non-operative treatment may be considered as a viable alternative therapeutic option for PUV in tiny babies facing prolonged intensive care unit stay.
Highlights
The affected population carries an almost 30% lifetime risk of end stage renal disease [1]. Such an unfavorable renal outcome is strictly related to the variable degrees of renal dysplasia that is associated with Posterior urethral valves (PUV)
PUV are often associated with a varying degree of oligohydramnios as a result of the inability of the PUV fetus to release urine, given the incomplete or intermittent obstruction of the urethra
We describe three premature PUV babies presenting with complicated medical conditions, in whom prolonged indwelling urethral catheterization, initially adopted as temporizing treatment for bladder decompression, allowed definitive PUV treatment
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Posterior urethral valves (PUV) are a rare congenital malformation occurring in 1 in every 5000–8000 pregnancies, and represents the most common cause of lower urinary tract obstruction in the newborn male. Posterior urethral valves (PUV) are the commonest cause of bladder out-let obstruction in male neonates, and a common cause of chronic kidney disease; in an ill, premature neonate with PUV, critical medical issues, urethral size, and anesthetic risks may complicate primary surgical treatment; urinary catheter represents the least invasive device to overcome initial PUV obstruction and allow adequate bladder decompression. Prolonged indwelling urethral catheterization may lead to definitive treat-ment in PUV patients facing long neonatal intensive care unit stays; PUV resolution may result from a combination of direct mechanical trauma caused by placement or inadvertent removal of the urinary catheter, and erosion caused by lateral pressure exerted by prolonged indwelling urethral catheter drainage; non-operative treatment may be considered as a viable alternative thera-peutic option for PUV in unstable premature babies
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