Temporary High Urinary Diversion with Valves Incision in the Same Procedure in Treatment of the Boys with Posterior Urethral Valves – 10 Years After

Abstract

Purpose There is a controversy regarding high urinary diversion in boys with posterior urethral valves (puv), because of the fear about bladder and upper urinary tract function after closure of the ureterocutaneostomy. We evaluated patients with puv after Sober en – Y or ring Williams ureterocutaneostomy with transurethral incision of the valves performed in the same procedure, 5 and 10 years after ureterocutaneostomy closure. Material and Methods Till 1997, 29 boys after puv had closured of the ureterocutanesotomies. The indication for high urinary diversion was hydroureteronephrosis and renal insufficiency (creatinine > 1 mg%). Ureterocutaneostomy closure with the reimplantation of the ureters was performed after 1 to 10 years (mean 3 years). In that moment 15 boys had mild dilatation of the upper tract, nobody had renal insufficiency, high voiding pressure was detected in 9 patients. We evaluated upper urinary tract condition, renal and bladder function, 5 and 10 years after closure of the ureterocutaneostomies. Results Upper urinary tract: five years after closure 11 boys had hydroureteronephrosis, 10 mild dilatation, 8 no dilatation; after 10 years 11 boys had hydroureteronephrosis, 9 mild dilatation, 9 no dilatation. Renal function: five years after closure renal insufficiency was observed in 8 patients, nobody had ESRD; after 10 years renal insufficiency was in 15 cases, and 5 were dialyzed. Bladder function: five years after closure normal bladder was in 12 boys, high voiding pressure in 12, unstable bladder in 4, bladder with small capacity in 1; after 10 years normal bladder was in 23, high voiding pressure in 5, unstable bladder in 1. There was no small bladder with impaired compliance. Conclusions In long-term follow-up after closure of the ureterocutaneostomies in puv upper urinary tract dilatation is stable, renal insufficiency grows with time. There is no deleterious effect on the bladder function; even bladder function improves with years.