Anterior Urethral Valves Research Articles

Delayed Presentation of Urethral Valves: A Diagnosis That Should Be Suspected Despite a Normal Prenatal Ultrasound.

Background. Congenital urethral obstruction occurs most frequently as a result of urethral valves. The diagnosis is usually confirmed pre- or neonatally. Though not ideal, delayed diagnosis can occur in childhood, adolescence, or adulthood. Despite a normal prenatal ultrasound, there may still be a delayed diagnosis of urethral valves. Methods. We present 4 patients with delayed diagnosis of posterior urethral valves (PUV) and 1 patient with delayed diagnosis of anterior urethral valves (AUV) who were evaluated by a pediatric urologist at our Institution. We determined the age and symptoms at presentation, physical examination, micturating cystourethrogram (MCU) findings prior to the valve ablation, renal function before and after valve ablation, type of valve ablation, and urine culture and sensitivity. The urological courses following urethral valve ablation including urodynamic study findings are described. Results. The median age at presentation was 33 months. All 5 patients presented with decreased urine output and urinary retention. All 5 patients underwent a MCU that demonstrated bladder trabeculations (3 cases), vesicoureteral reflux (3 cases), and bladder diverticula (2 cases). A urethral valve ablation was performed in all cases. Four patients underwent a renal function panel prior to this procedure, and their serum BUN/creatinine levels decreased 1 day postoperatively. Conclusion. Pediatricians should consider urethral valves as causing urethral obstruction although the prenatal ultrasound may be normal. Early diagnosis and prompt treatment of urethral valves may mitigate the potentially devastating morbidities such as renal failure, congestive heart failure, and respiratory distress that may ensue.

Prenatal diagnosis and postnatal outcome of anterior urethral anomalies.

Anterior urethral anomalies (AUA) which present as anterior urethral valve, stenosis or atresia, are a rare cause for congenital urinary tract obstruction. We present our AUA prenatal diagnosis case series. Fetuses presenting with prenatal findings suggestive for AUA according to postnatal reported clinical and imaging signs (urinary tract dilatation, dilated bladder, enlarged edematous fetal penis, dilatation of the fetal urethra and diverticula) were followed prospectively. Six fetuses were diagnosed with AUA. Diagnosis was confirmed upon examination of the neonate or the abortus. All cases presented with variable degrees of urinary tract dilatation. Four fetuses who presented with additional congenital anomalies of the kidneys and urinary tract (CAKUT) developed intra-uterine or early postnatal renal failure, while two isolated AUA cases have a normal renal outcome. AUA is a rare diagnosis. However, high index of suspicion and careful sonographic assessment of the male fetal urethra in cases referred for urinary tract dilatation may enable appropriate parent counseling, optimal prenatal surveillance and timed postnatal urological intervention. As in other lower urinary tract obstructions, future renal function seems to correlate with associated CAKUT, therefore close follow up throughout pregnancy and meticulous sonographic assessment is recommended.

EP17.22: A case report about a suspicion of an anterior urethral valve discovered in an 18‐week fetus, spontaneously resolutive at 22 weeks of gestation

EP17.22: A case report about a suspicion of an anterior urethral valve discovered in an 18‐week fetus, spontaneously resolutive at 22 weeks of gestation

Double Urethral Valve: a Clinical Case

Introduction. Urethral valves (UVs) are congenital malformations of the urethra, leading to infravesical obstruction. The most common UV is the posterior urethral valve (PUV). The anterior urethral valve (AUV) is a somewhat rarer, but still well-known congenital anomaly. UVs can provoke significant obstruction of the proximal urinary system, which can later lead to disability of children and more frequent deaths.Materials and methods. The article presents a clinical example of a 32-year-old man with a congenital double urethral valve occuring in the anterior and posterior urethra, which led to the development of chronic urinary retention, urinary tract infection and chronic renal failure. The patient underwent a successful urethroplasty operation to remove the valve mechanism.Results. Six months following surgery, the patient noted the complete disappearance of symptoms, with renal function having returned to normal. No signs of recurrence of the disease or the formation of stricture of the urethra were detected by to the survey.Conclusion. A congenital variant of the double UV is an unusual extremely rare cause of infravesical obstruction. Early diagnosis and treatment of this anomaly is very important for preventing further irreversible damage to the urinary system. The presented clinical observation demonstrates the need to organise and conduct periodic preventive examinations of children of different age groups.

An Anterior Urethral Valve without Urethral Dilatation Diagnosed by Cystoscopy in a Neonate

An Anterior Urethral Valve without Urethral Dilatation Diagnosed by Cystoscopy in a Neonate

Long-term renal outcome in infants with congenital lower urinary tract obstruction

Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. 4.

Symptomatic Male Urethral Diverticula- Presentation, Diagnosis and Management.

ABSTRACTObjective- To report our experience of aetiology, diagnosis, management and outcomes of uncommon male urethral diverticula managed at a single institute.Patients and Methods: After due approval from local ethical committee the case records of 8 male patients including a child presenting with urethral diverticula in a 10 year period (2002-2012) were retrospectively analysed with regard to presentation, diagnosis, management and outcomes.Results: A total of eight patients were identified having been managed for a urethral diverticulum during the period. Of the eight patients one was congenital diverticulum and rest acquired. A child aged 10 years, presented with straining to void and inability to empty the bladder and was diagnosed to have anterior urethral valve located at peno-scrotal junction. The valves were endoscopically resected and diverticulum de-roofed. The child recovered with good outcome of good flow and emptying of bladder. Patients with acquired diverticula, presented at a mean age of 42 years (25-60 years). The presentation was similar with two patients presenting with acute retention. The Aetiological factors included Trauma, Previous urethral surgeries like Visual internal urethrotomy and infection. The common site of diverticula was peno-scrotal junction, followed by distal penile urethra. Two patients were treated with primary excision and establishment of urethral continuity and rest with two stage procedures. The outcome was poor in one patient of primary excision who presented later with stricture at the anastamotic site.Conclusions: Unlike in female population, male urethral diverticula are uncommon but should always be thought of in young men with obstructive urinary symptoms and in those with a past history straddle injuries. Treatment if individualized leads to good outcomes.

Congenital Diverticulum at the Proximal Part of Penile Urethra with Secondary Calculus

Voiding dysfunction and lower urinary tract symptoms (LUTS) in children due to congenital anomalies of urogenital system is common, but congenital anterior urethral diverticulum (CAUD) in male is very rare. Sometimes the problem is associated with anterior urethral valve. CAUD with secondary stone is rare. Here we report a case of a 12-year-old male child with obstructive symptoms. It was treated by excision of diverticulum, removal of stone and primary repair.J Enam Med Col 2017; 7(3): 162-164

Anterior urethral valves without diverticulum, a rare cause of infravesical obstruction and vesicoureteral reflux in children: Report of two cases and literature review

Congenital anterior urethral valve is a rare condition causing significant obstructive uropathy in pediatric age group. It is much rarer than posterior urethral valve. However, the clinical course is similar. We present two cases of anterior urethral valves in children.

Anterior Urethral Valve: Uncommon Association with Renal Duplicity.

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

WSPÓŁISTNIENIE ZASTAWKI CEWKI PRZEDNIEJ I TYLNEJ U NOWORODKA. CZY ROZPOZNANIE KOINCYDENCJI WAD NA PODSTAWIE OBJAWÓW KLINICZNYCH I BADAŃ OBRAZOWYCH JEST MOŻLIWE?

We present a rare association of anterior and posterior urethral valves. A 5 days-old boy was admitted because of clinical presenation of lower urinary tract obstruction. A renal ultrasound and voiding cysto-urethrography revealed obstructive pathology in anterior urethra. On endoscopy an association of anterior and posterior urethral valves was recognized, and the valves were incised. Follow-up demonstrated improvement of preoperative signs. We try to recognize an association of anterior and posterior urethral valves in radiological examinations.

Clinical report in treating children with concomitant anterior and posterior urethral valves

Objective To investigate the approach to reduce diagnostic error of concomitant anterior and posterior urethral valves. Methods The clinical data of 3 patients was retrospective analyzed, who was with concomitant anterior and posterior urethral valves admitted from January 2010 to October 2015.The literatures of the similar cases were reviewed. The 3 patients were all male, and the average age was 5 months (3 - 7 months) at diagnosis. The patients with remaining obstructive symptoms after the release of the posterior urethral valves underwent VCUG, cystoscope, and further surgical treatment for anterior urethral valves. Results Posterior urethral valves were found in all the 3 patients at diagnosis and were fulgurated. However, clinical symptom improvement was not obvious. Anterior urethral valves were indicated by VCUG and then fulgurated in all 3 patients. Thereafter, all clinical symptoms were improved significantly. Conclusions It was necessary to reexamine by VCUG, urodynamics, and cystoscope in the patients without obvious improvement after fulguration of posterior urethral valves, in order to avoid diagnostic error of concomitant anterior and posterior urethral valves. Key words: Anterior urethral valves; Posterior urethral valves; Obstruction; Prognosis

Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two year old boy: A case report and a review of the literature

Anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children. These are much rarer than posterior urethral valves. We report a case of a child with AUV and high grade bilateral vesicoureteric reflux. He was managed by transurethral laser ablation. The left sided reflux resolved after ablation. The right sided reflux persisted. The child is awaiting ureteric reimplantation.

Glanular Anterior Urethral Valve; A Case Report of an Unusual Cause of Neonatal Urinary Retention

Anterior urethral valve is an uncommon abnormality whose etiology is uncertain, unlike in the case of posterior urethral valve. Glanular anterior urethral valve is even rarer. We present an unusual case of anterior urethral valve, which presented with acute urinary retention and was successfully managed with excision and glans reconstruction. A history of poor stream and dribbling, recurrent urinary tract infections and palpable penile or peno-scrotal mass strongly points to the diagnosis of anterior urethral valve. A voiding cystourethrogramme confirms the diagnosis. It can cause early proximal urinary tract damage and renal failure if not intervened in time. Early surgical intervention will prevent the onset of uremia. Transurethral resection is the treatment of choice.

Male urethral diverticulum uncommon entity: Our experience

Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall. Case 2A: 30 year male with obstructive lower urinary tract symptoms (LUTS). Retrograde urethrogram (RGU) revealed bulbar urethral diverticulum akin to anterior urethral valve, managed endoscopically. 1 year follow up urine stream satisfactory. Case 3A: 27 year male previously operated large proximal bulbar urethral stone with incontinence. RGU large proximal bulbar UD with wide open sphincter. Treated with excision of excess diverticular wall and penile clamp with pelvic exercises for incontinence. Congenital UD develops due to imperfect closure of urethral fold, Acquired UDs occurs secondary to stricture, infection, trauma, long standing impacted urethral stones or scrotal / skin flap urethroplasties. RGU and MCU are the best diagnostic technique to confirm and characterize the UD. Urethral diverticulectomy with urethral reconstruction is the recommended treatment for UD. UD is a rare entity. Especially in males, congenital are even more rare. Management should be individualized. Surgery can involve innovation and/or surgical modifications. We used excess diverticular flap for stricture urethroplasty in one case.

Missed Diagnosis of Anterior Urethral Valve labelled as Neurogenic Bladder

Anterior urethral valve (AUV) is a long known but rare anomaly, which is occasionally encountered in boys with obstructive uropathy. We present a case of Anterior urethral valve which was misdiagnosed as neurogenic bladder and was planned for Augmentation cystoplasty with catheterizable stoma elsewhere. This article highlights the frequently missed diagnosis of Anterior urethral valve by most practitioners because of its rarity. JMS 2015; 18(2):150-152

MP79-15 UROLOGICAL COMPLICATIONS IN PEDIATRIC PATIENTS UNDERGOING RENAL TRANSPLANTATION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-15 UROLOGICAL COMPLICATIONS IN PEDIATRIC PATIENTS UNDERGOING RENAL TRANSPLANTATION Irina Stanasel, Cagatay Afsarlar, Hoang Lee, Abhishek Seth, Chester Koh, Patricio Gargollo, Edmond Gonzales, David Roth, and Nicolette Janzen Irina StanaselIrina Stanasel More articles by this author , Cagatay AfsarlarCagatay Afsarlar More articles by this author , Hoang LeeHoang Lee More articles by this author , Abhishek SethAbhishek Seth More articles by this author , Chester KohChester Koh More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , Edmond GonzalesEdmond Gonzales More articles by this author , David RothDavid Roth More articles by this author , and Nicolette JanzenNicolette Janzen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2872AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal transplantation is the management of choice for children with end stage renal disease (ESRD). We performed a retrospective analysis of patients undergoing renal transplantation at a children's hospital in order to evaluate the prevalence and type of urological complications in this patient population. METHODS A retrospective chart review of 100 consecutive children who underwent renal transplantation at a children's hospital between January 2009 and April 2014 was performed. Forty three females and 57 males were identified. The cohort included 37 children who underwent renal transplantation from a living related donor and 63 children who had a renal graft from a deceased donor. The average age at time of transplant was 14.04 years. Twenty six of the 100 children reviewed had a urological etiology for ESRD (posterior or anterior urethral valves, reflux nephropathy, Prune Belly Syndrome, or neurogenic bladder.) All children had a non-refluxing anastomosis performed by either the pediatric transplant surgeon (78) or a consulting pediatric urologist (22.) Four children had a ureteral stent placed at time of reimplantation. RESULTS Children who experienced renal complications were younger at time of renal transplantation, with an average age of 10.5 vs 14.04 years. Postoperatively, all patients underwent follow up with ultrasonography. If hydronephrosis was demonstrated on ultrasound or if the patients developed a urinary tract infection (UTI), patients also underwent a voiding cystourethrogram (VCUG). In cases of suspected obstruction, a MAG-3 renogram was performed. These outcomes are detailed in Figure 1. Twenty six children had a urological reason for ESRD, 11 of whom (42%) developed a urological complication. Of 74 patients without a urological reason for ESRD, 18 (24%) developed urological complications (p=0.13). CONCLUSIONS Children with urological reason for ESRD trend toward having more urological complications. We observed an overall low rate (29%) of urological complications. Although when patients had a UTI a VCUG detected reflux in 15 of 23 patients (65%), our data suggests that performing a VCUG for all transplant patients is unnecessary, and one can be performed if the patient demonstrates hydronephrosis or develops a UTI post-operatively. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1016 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Irina Stanasel More articles by this author Cagatay Afsarlar More articles by this author Hoang Lee More articles by this author Abhishek Seth More articles by this author Chester Koh More articles by this author Patricio Gargollo More articles by this author Edmond Gonzales More articles by this author David Roth More articles by this author Nicolette Janzen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Concomitant anterior and posterior urethral valves in pediatrics: A single center experience over 12 years and long-term follow up after endoscopic treatment.

To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves. We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded. From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients. Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves.

Anterior Urethral Valve- Rare cause of Urethral Obstruction- A case Report

Anterior urethral valve (AUV) is extremely rare entities. It is an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. The symptoms mimic those of posterior urethral valves. Because of rarity, less common presentations in children and lack of awareness among the pediatrician and pediatric surgeons, it can be easily missed.

Anterior Urethral Valve and Diverticulum in a Neonate with Urinary Tract Infection

Introduction:Anterior urethral valve (AUV) is a rare congenital anomaly that can cause obstructive uropathy. AUV can lead to variable urinary tract symptoms, and if left untreated, it can result in end-stage renal disease. AUV should be immediately evaluated and managed. Herein, we present a neonate with AUV and diverticulum, who was treated by cystoscopy. Case report:A 11-day-old boy was referred to the nephrology department for evaluation of urinary tract infection, which was developed 2 days prior to admission. Pregnancy and routine ultrasound (US) were normal, and urinalysis showed pyuria. Routine investigations included blood urea nitrogen, serum creatinine, electrolyte panel, urine analysis (UA), and urine culture (UC). Abdominal US examination displayed a normal bladder with normal kidneys. A voiding cystourethrogram (VCUG) showed an anterior urethra diverticulum with dilation of the proximal urethra and trabeculated bladder; however, no vesicoureteral reflux was observed. Finally, the patient underwent endoscopy. Discussion: AUV is a congenital mucosal fold, located distally to the membranous urethra. AUV can be located anywhere distal to the membranous urethra and is found in bulbar urethra (40%), penoscrotal junction (30%), pendulous urethra (30%), and occasionally in the fossa navicularis, respectively. The exact etiology of this disease is unclear. AUV with associated diverticulum is a rare congenital urethral anomaly that can lead to penile swelling, urethral obstruction, urinary retention, incontinence, nocturnal enuresis, bladder rupture, and end-stage renal disease. Depending on the severity of anatomical obstruction, this condition may present soon after birth or later during childhood. VCUG is the most important imaging technique for the evaluation of urethral abnormalities. Congenital AUV in children has a generally good prognosis, but may occasionally result in poor renal outcomes such as renal insufficiency, renal failure, and patient‘s death.