Poor Stream Research Articles

Role of MCU in the Management of Posterior Urethral Valves

Objective: In infancy, the most common cause of bladder outlet obstruction is Posterior urethral valves (PUV), which impair renal and bladder function. This study was planned to evaluate and record the role of MCU in the various clinical presentations and management, complications, surgical management, and long-term outcomes of PUV. Methods: In this study, 49 patients treated for PUV were evaluated at the Bangladesh Shishu Hospital and Institute from May 2018 to April 2021. Complete data were taken, paraclinical examinations were performed on each patient, and the diagnosis was confirmed by micturating-cysto-urethrography (MCU). Posterior urethral valves were ablated in all patients using an electric hook. Results: A total of 49 patients with a mean age at diagnosis of 42(±21) days were included in this study. Catheterization was done within one to 5 days of life in 29 patients. PUV was ablated by an electric hook in all 49 patients. The most common symptoms in our group were dribbling, poor stream (71%), and urinary tract infection (UTI) (46%). There was vesico-ureteral-reflux (VUR) in 52% and hydronephrosis in 92.5%. The most common associated anomaly was kidney anomalies (Renal agenesis/dysplasia and multicystic kidney disease) in 4(8.2%) patients. About ten patients had prenatal diagnosis of PUV. Complications occurred in two (4.2%) patients. Mortality occurred in 3 (6.4%) patients. The mean follow-up period was 3.2±0.8 years (1.5 months to 4 years). Conclusion: MCU is the gold-standard imaging modality for documenting PUV and Postoperative follow-up to assess the condition of the posterior urethra urinary drainage by catheter in the early days of infancy. The factors like renal dysplasia and UTI have their role in the outcome.

The Diagnostic Value of bpMRI in Prostate Cancer: Benefits and Limitations Compared to mpMRI.

Prostate cancer is the second most common cancer in men and a leading cause of death worldwide. Early detection is vital, as it often presents with vague symptoms such as nocturia and poor urinary stream. Diagnostic tools like PSA tests, ultrasound, PET-CT, and mpMRI are essential for prostate cancer management. The PI-RADS system helps assess malignancy risk based on imaging. While mpMRI, which includes T1, T2, DWI, and dynamic contrast-enhanced imaging (DCE), is the standard, bpMRI offers a contrast-free alternative using only T2 and DWI. This reduces costs, acquisition time, and the risk of contrast-related side effects but has limitations in detecting higher-risk PI-RADS 3 and 4 lesions. This study compared bpMRI's diagnostic accuracy to mpMRI, focusing on prostate volume and PI-RADS scoring. Both methods showed strong inter-rater agreement for prostate volume (ICC 0.9963), confirming bpMRI's reliability in this aspect. However, mpMRI detected more complex conditions, such as periprostatic fat infiltration and iliac lymphadenopathy, which bpMRI missed. While bpMRI offers advantages like reduced cost and no contrast use, it is less effective for higher-risk lesions, making mpMRI more comprehensive.

Posterior urethral valves: Clinical audits of presentation, diagnostic and therapeutic intervention in a nigerian teaching hospital.

We described our experience in the management of PUV at UNIOSUN Teaching Hospital, Osogbo, Osun State. This was a retrospective analysis of patients with diagnosis of PUV carried out over a 4year period (2019-2023). Demographic characteristics, clinical presentation, diagnosis and mode of therapeutic interventions were the variables analysed. A total of 17 patients with PUV were managed during the study period. Median age at presentation and surgery were 10months (range 3.0-48.0) and 13months (range 3.0-49.5), respectively. Most common presentation was poor urinary stream, 11 (64.7%). Mean PCV was 34.42%. Klebsiella aerogens was the predominant 9 (52.9%) organism isolated. A patient had prenatal USS diagnosis suggestive of PUV, majority (52.9%) had bilateral grade 1V hydronephrosis at presentation. Voiding cystogram was diagnostic in 14 patients, (82.4%) while urethrocystoscopy was done in 14 (82.4%) patients. Median creatinine level were 116, 76.5 and 51.0 (micromol/l) pre- and post-catheterization and 1month post-surgery, respectively. There was positive correlation between the age and post- surgery creatinine but a negative correlation between the PCV and grade of hydronephrosis. All patients had Mohans valvotomy. We had mortality in a patient from urosepsis. At 6months-1year follow-up, 15 patients had good urine stream with stable renal function. Early intervention assist in optimizing renal and bladder function and minimize risk of urosepsis. Where there is no facility for endoscopic valve ablation, Mohans valvotomy remains a viable treatment option.

Clinicopathological Study of Prostate Diseases and Its Correlation with PSA Level, Size of Prostate and Gleason’s Scoring System in Case of Prostatic Carcinoma

Background: Prostate gland diseases significantly impact adult males globally, with an increasing prevalence due to aging populations. The primary conditions affecting the prostate are inflammation, benign prostatic hyperplasia (BPH), and tumors, with BPH being the most common. Prostatic carcinoma is also prevalent, with a high lifetime risk. Prostate cancer incidence increases with age, and early detection relies on digital rectal examination, transrectal ultrasonography, and PSA testing. Aim of the study: The study aims to find out correlation between PSA, Gleasons scoring system and HER-2/NEU gene in prostatic cancer. Methods: This study, conducted from July 2017 to June 2019 at BIRDEM General Hospital, enrolled 110 male patients aged 50-100 with clinical signs of prostatic diseases. Patients provided written informed consent and met specific inclusion criteria. Specimens were obtained via TURP, simple or radical prostatectomy, preserved in 10% neutral buffered formalin and examined for pathological lesions. PSA levels were measured using an immunoassay, and Gleason scoring was used for carcinoma categorization. Data were collected via questionnaires and analyzed using SPSS software. Result: The study analyzed 110 prostatic disease cases, with patients averaging 67.7 years. The most common diagnosis was BPH with inflammation (50.9%), followed by BPH without inflammation (35.5%) and adenocarcinoma (13.6%). Urgency (80%), increased micturition frequency (78.2%), poor stream (78.2%), and urinary retention (77.3%) were the most common symptoms. There was a significant correlation between serum PSA levels and prostate size (p < 0.001), with higher PSA levels indicating larger prostates and a higher likelihood of adenocarcinoma. The most frequent Gleason score was 4+4=8 (40%). HER2/neu overexpression showed a marginal correlation with PSA levels (p=0.053). Conclusion: The study found that the most common age group for prostatic diseases was 61-70 years. Benign prostatic hyperplasia (BPH) was the most frequent lesion. Grade II (31-50g) prostate size was common on ultrasound. Most patients had a PSA level of 0-5 ng/ml, aiding early diagnosis and reducing morbidity

An Update on the Conservation Status Assessment of two Endangered Freshwater Mussel Species in Bavaria, Germany

ABSTRACTThe two highly endangered European mussel species Margaritifera margaritifera and Unio crassus are target species of conservation. Based on a recently completed systematic state‐wide monitoring of each 22 M. margaritifera and 22 U. crassus streams in Bavaria, Germany, we present an update on population trends, conservation status, habitat quality and threats for both species. Populations status and habitat quality varied strongly between M. margaritifera and U. crassus streams, but there was also great variability within each of those groups. The population decline of M. margaritifera has continued, albeit higher proportions of juveniles originating from artificial breeding programmes have been established in some streams. Habitat quality often did not match known requirements as evident from poor stream bed quality, lack of hosts and elevated nutrient levels. In contrast, U. crassus populations showed a better status, with an increase in population size over all sampled streams. Successful recruitment was indicated by high proportions of juveniles. However, no mussels older than 16 years were found, probably due to predation and structural stream maintenance measures. Climate change effects, such as extreme droughts, affected both species. This study demonstrates different needs in conservation management for both species. Although mitigation of drought effects is commonly needed for both species, tackling host fish management and direct threats such as predation should be prioritized in U. crassus, whereas restoration of prime habitat quality and intact catchments is key to enable natural recruitment and sustainable populations of M. margaritifera.

Comparative Outcomes of Monopolar and Bipolar Transurethral Resection of the Prostate: An Institutional Perspective.

Objective This prospective comparative study aimed to highlight and compare two types of transurethral resection of the prostate (TURP), namely M-TURP (monopolar) and B-TURP (bipolar), in the endoscopic management of benign prostatic hyperplasia (BPH). Methods and materials This research was conducted between 2022 and 2023 at a tertiary care health center. Included in the investigation were 100 consenting study participants undergoing M-TURP and B-TURP at our center. All referred patients presenting with clinical, ultrasound, or uroflowmetry features of BPH and those with failed attempts at medical management were included in the study. Patients with carcinoma of the prostate were excluded from the study. Post-operatively, the endpoints for comparison included maximal urinary flow rate (Qmax), prostate volume, duration of hospital stay, duration of catheterization, drop in serum sodium concentration, and drop in hemoglobin levels. Descriptive statistics were computed to delineate the study sample. After the completion of data collection, data analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, IL, USA), and the correlations sought were achieved using the Chi-square test of significance. Results The peak incidence of BPH was seen in the sixth decade of life: the M-TURP group was 65.16 ± 7.07 years (mean ± standard deviation), while that in the B-TURP group was 62.32 ± 8.16 years (mean ± standard deviation). Nine percent of the study participants did not show any comorbidities. The most frequent symptom of BPH at presentation was a poor urinary stream (78%, n = 100), followed by nocturia (67%, n = 100). In our study, patients undergoing M-TURP had a mean serum prostate-specific antigen (PSA) level of 4.31 ± 1.03 ng/mL, while patients undergoing B-TURP had a mean serum PSA of 4.24 ± 0.99 ng/mL (p = 0.820; p > 0.05). The study found that patients undergoing M-TURP had a mean prostate size of 35.04 ± 3.57 cc, while those undergoing B-TURP had a mean prostate size of 35.72 ± 3.22 cc (p = 0.765). For the B-TURP group, the mean decrease in postoperative serum sodium concentration was 4.3 mEq/L, while for the M-TURP group, it was 6.4 mEq/L (p = 0.903). In the M-TURP group, there were three cases of transurethral resection (TUR) syndrome, while the B-TURP group had only one case. Conclusion BPH is a common problem affecting the quality of life of several male patients. Both M-TURP and B-TURP are comparable in their efficacy in treating BPH, with the exception of a higher incidence of hyponatremia and TUR syndrome in the M-TURP group.

Benign Prostate Hypertrophy: An Educational Ultrasound Images and Pharmacotherapy Mini-Review

Background: A benign increase in the size of prostate (Enlargement) can be asymptomatic, but it can cause symptoms resulting from pressure on the urethra, including frequency of urination, difficulty in starting urination, poor urine stream, dribbling after urination, and inability to pass urine. Ultrasonography has been used as early as 1971 for the diagnosis of prostatic enlargement. Patients and Methods: The case of a 53-year old diabetic and hypertensive male who had refractory psoriasis and developed benign enlargement is described and an educational ultrasound images are presented. Results: The patient was complaining of dribbling after micturition for few weeks. He was not having difficulty in starting urination nor complained of frequent micturition, and the urine stream was considered normal. The urinary bladder was normal, but with mild hazy wall outline. Pre-voiding volume was 248 ml, and post-voiding volume was 9 ml. Ultrasound of the prostate showed enlarged prostate with homogenous texture. Prostate volume was 36.6 ml (Normal: 25 ml). Therefore, Oral finasteride was started. Conclusion: Many medications have been used in the treatment of benign enlargement of the prostate during the 1960s, 1970s, and 1980s, including progestational agents, Amino acids, spironolactone, candicidin, nystatin, flutamide, bromocriptine, alpha-adrenergic blockers, Serenoa repens (Saw palmetto extracts), and mepartricin. However, the current evidence-based opinion suggests that benign enlargement of the prostate can be initially treated with medications that can reduce the volume of the prostate such as finasteride and dutasteride. Tamsulosin or alfuzosin can be added to further improve lower urinary symptoms.

Sacrococcygeal teratoma: an experience from a high-volume tertiary institute in North India

Background: Sacrococcygeal teratoma (SCT) is the most common tumour in the newborn. The majority is present in neonates as a sacral mass; however, some may be present late with varied clinical presentation. The study aims to evaluate the clinical presentation and management of patients with SCT in our high-volume tertiary institute in North India. Methods: This is an observational study of infants and children treated between May 2021 to April 2022 in the department of pediatric surgery, SMS Medical College, Jaipur (a high-volume tertiary institute in North India). Data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, Altman classification, surgical approach, histopathology and complications. Functional results were evaluated clinically and radiologically. Results: Twenty-one patients (M: F=1:3.2) with a median age of 40 days (range: 1 day to 5.8 years) with SCT were managed at our centre. Nearly, two-thirds of the tumors were either Altman type 1 or 2. Yolk sac tumour was present in 2 (9.5%) patients, while the rest had either mature or immature teratoma. Tumours were removed through a posterior sagittal approach (chevron incision). In five patients, an abdominoperineal approach was used. Early complications were surgical site infection (n=5; 23.8%), superficial wound dehiscence (n=2; 9.5%), complete wound dehiscence (n=1; 2.4%), and urinary tract infection (n=1; 4.7%). Late complications were urinary dribbling or poor stream (5/21; 23.8%) and faecal soiling (n=3; 14.2%). Conclusions: Most of the sacrococcygeal tumours are benign, and the incidence of malignancy increases with age. Morbidity due to associated malformation and treatment may persist in these patients, especially like urinary complications stream (one-fifth) and faecal incontinence (one-seventh), as seen in our series. A proper long-term follow-up is needed for the management of late complications.

Clinical Profile, Management, and Outcome of Posterior Urethral Valves in Children - Experience from a Tertiary Care Hospital.

Posterior urethral valves (PUV) are the most common obstructive anomaly of the lower urinary tract in children. End-stage renal disease (ESRD) in 17% of the children is due to PUV. The present study helps know the spectrum of the disease, management options, and the outcome in these children. The present study is a descriptive type of study by review of medical records of all the children presented to the hospital from 2015 to 2019. Profile of PUV includes any abnormality in antenatal ultrasonography (USG), age at presentation, presenting complaints, general condition at the time of presentation, biochemical investigations like serum creatinine and electrolytes at admission, clinical progression during hospital stay and the type of intervention. Outcome variables studied were improvement in the stream and overall well-being of the child, renal function, recurrent urinary tract infections (UTIs). Follow-up period varied from 1 to 6 years. A total of 73 patients were included in the study. The mean age of presentation was 3.4 years. The most common presenting complaints were poor urinary stream and dribbling of urine. Antenatal USG showed abnormality in 23 patients. Renal function was abnormal in 28 patients. Out of 73 patients, 51 underwent endoscopic ablation of valves, 19 underwent vesicostomy, and three patients underwent supravesical diversion. During the follow-up recurrent UTI was observed in 11 patients, 15 patients progressed to chronic kidney disease, and 15% of patients were hypertensive. Mortality in the present study was 4%. PUV includes a spectrum of diseases from mild form to lethal conditions. Early intervention by relieving obstruction may prevent or delay the ESRD; hence, timely intervention is necessary in these children.

Non-Neurogenic ‘Christmas Tree’ Urinary Bladder in A 30-Year-Old Man with Urethral Stricture: A Case Report

condition the urinary bladder appears elongated and pointed with a thickened, trabeculated wall likened to a Christmas tree. It is most commonly the result of neurogenic bladder from detrusor hyperreflexia which most commonly occurs after spinal trauma. Christmas tree bladder also may rarely be seen in cases of bladder neck obstruction of non- neurogenic cause. A 30-year-old male presented with two weeks history of leakage of urine par the perineum. There was prior history of urethral discharge, poor urinary stream, urine dribbling and dysuria. No history of genital trauma, urethral instrumentation or catheterization in past. Attempt at passage of urethral catheter failed. He subsequently had open supra pubic cystostomy. Ultrasonography shows multiple internal echoes in the urine with thickened irregular bladder wall. The upper urinary tract was normal. Combine RUG and VCUG demonstrate short segments strictures at the bulbar and membranous urethra. A track of contrast column was noted from the region of the bulbar stricture to the exterior consistent with urethro-cutaneous fistula. The urinary bladder appears large, elongated superiorly with irregular outline resembling ‘Christmas tree’ configuration.

SUCCESSFUL TRANSURETHRAL RESECTION OF ANTERIOR URETHRAL VALVE IN CHILDREN : A CASE REPORT

Objective: This case report will present transurethral resection of double anterior urethral valves in tertiary hospital. Case(s) Presentation: A three-year-old boy who complained of a poor stream of urine and discomfort during micturition. From the radiological examination, the main finding was found on ultrasound (USG), with thickening of the bladder wall without upper tract abnormality. On panendoscopy, we found double anterior urethral valves at bulbar part and trabeculation in bladder. Discussion: The resection of the valves was performed and achieved an excellent result included normal stream of urine and there was no discomfort during micturition. Conclusion: Anterior Urethral Valve is a rare case that can be caused a lower urinary tract obstruction. A good understanding of AUV’s radiological and endoscopic anatomy is required to differentiate it from other diseases, essential to prevent further injury, and also to decide for appropriate management.
 Keywords: Anterior Urethral Valve, Congenital Anomaly, Urinary Obstruction

Transurethral Vaporization of Bladder Neck Using Holmium Laser: First Experience in Manado

Abstract: Bladder neck contracture (BNC) is a potential complication after radical prostatectomy (RP). This may be a result of inadequate approximation at the time of surgery, urinary extravasation, or distraction of the bladder neck from a hematoma. Patients commonly complains of a poor urinary stream or prolonged unexplained incontinence. Treatment of BNC requires a tailored approach and can range from simple, office-based procedures to complex surgical reconstruction. We reported a case of 81-year-old male complaining urine retention for one month. The patient had previous open prostate procedure a year prior. On examination, neurogenic causes were excluded. Retrograde ureterocystography revealed bladder neck contracture. Patient was diagnosed as bladder neck contracture post open prostatectomy surgery. Transurethral holmium laser vaporization with 800 micrometre, 20 Hz frequency and 4,5 Joule of power. through a ureteroscope was performed. Two-way Folley catheter 18Fr was inserted without irrigation. Patient was discharged post-surgery two days after catheter removal and spontaneous micturition. Endoscopic balloon dilatation with incision appears to offers promising result in the management of BNC. The consideration of using transurethral vaporization with holmium laser modality was the first procedure ever done in Manado. In conclusion, TUVP is one of the alternatives, minimally invasive procedures to treat BNC. The use of holmium laser for the incision of bladder neck is another alternative to treat BNC with great outome proven by the length of stay (LOS) of two days after the procedure was done. Keywords: bladder neck contracture; transurethral vaporization; holmium laser; post prostatectomy

Posterior urethral valve in thai boys

BackgroundPosterior urethral valve (PUV) is the most common congenital bladder outlet obstruction in boys, causing renal damage beginning in utero. There are scarce data from Thailand regarding the long-term outcomes of PUV in boys, thus the aim of this study was to examine the presentation, clinical course, complications, outcomes and renal survival in PUV boys.MethodsWe reviewed the medical records of PUV boys treated at the Pediatric Nephrology Clinic, Prince of Songkla University, Thailand, over a 30-year-period.ResultsSeventy-seven PUV boys were identified, with a median age at diagnosis of 4.8 months. The most common presentations were urinary tract infection (UTI), poor urine stream and urinary dribbling in 26 (33.8%), 19 (24.7%) and 11 (14.3%) boys, respectively. Renal ultrasound results in 70 boys showed 8 (11.4%) unilateral and 56 (80%) bilateral hydronephroses. Of 72 voiding cystourethrograms, 18 (25.0%) showed unilateral and 22 (30.6%) bilateral vesicoureteral refluxes. 99mTc dimercaptosuccinic acid renal scans in 30 boys showed 12 (40%) unilateral and 8 (26.7%) bilateral renal damage. Fifty-nine (76.6%) boys had 149 UTIs; 42 (54.4%) had recurrent UTI. Forty-eight boys had valve ablation at the median age of 30.3 months. 22 boys (28.6%) developed chronic kidney disease (CKD) at a median age of 15.0 years.ConclusionOf 77 PUV Thai boys, UTI was the most common presentation. Recurrence of UTI and CKD was the most common consequence. Lifelong follow-up for renal and bladder functions is essential for all PUV patients.

(133) Ambigous Genitalia in a 22 year old woman: A Case Report of Successful Perineoplasty and Clitoroplasty

Abstract Introduction External genitalia are considered to be ambiguous whenever there is difficulty assigning gender to a child based on the appearance of the external genitalia. It is a common presentation of Disorders of Sexual Development (DSD). Objective Reported here is the case of a 22year old single undergraduate identified as female who had disorder of sexual development with ambiguous genitalia resulting from congenital adrenal hyperplasia. Methods Although the appearance of her genitalia in childhood could not be ascertained, she presented with inability to achieve penetrative vagina intercourse, enlarged clitoris with dissatisfaction and distress about the appearance of her genitals, poor urinary stream and terminal dribbling. On examination she had clitoromegaly with fused labia minora at the midline which formed anterior to the urethral meatus as shown in Fig 1.1. She had acne and hirsutism. Investigations done show hyperandrogenism and were suggestive of congenital adrenal hyperplasia with no salt wasting. Results She had successful perineoplasty and clitoroplasty with satisfactory appearance of her genitalia, she has been able to achieve penetrative vagina intercourse with satisfactory sexual function and urinary streams have improved with terminal dribbling resolved. Conclusions Disorders of sexual developments though rare may have significant psychosocial effects on its victims and understanding the pathology with surgical intervention as indicated in this case may be helpful to improve the quality of life of the affected persons. Disclosure No

Impact of Poor Stream Conditions on the Health of Stream Workers in Umlazi, KwaZulu-Natal, South Africa

Despite increased efforts by the South African Government to minimise environmental degradation, the surface water in urban water sources is still highly polluted. This is a hazard to many urban and suburban communities and workers who use the water from urban river environments. In this study, we aim to determine the impact of poor stream conditions on the health of stream workers in Umlazi. We used the Health Belief Model as a conceptual framework to explore the susceptibility to and the severity of health hazards that affect stream workers’ health state. A qualitative case study design was used. The data were collected through interviews (n = 25) from community-based cooperatives and employees of municipality departments who are involved in the management of streams in the Umlazi Township. The data were recorded, transcribed, coded and thematically analysed. Current stream conditions were perceived to be deteriorating, which affected stream workers’ health and perception of safety. The streams were noted to have medical waste, venomous snakes, other pests and insects, sewer leakages and illegal sewer connections created to compensate for the general lack of services from the municipality. Cholera and diarrhoea were identified as the prominent health threats because of the prevailing stream conditions. Improving the working conditions of sanitation workers would contribute to ensuring the health and promoting the well-being of all people of all ages in the area by reducing their exposure to unsafe chemicals on the job, ensuring sustainable management of water and sanitation for all and providing decent work conditions.

Congenital anterior urethral diverticulum in children: case series and review of the literature

BackgroundCongenital anterior urethral diverticulum (CAUD) is a rare condition in children. This condition can present at any age; however, it is more commonly identified in infants and older children. The patient may present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. Children with large anterior urethral diverticulum with poor spongiosal support may also complain of cystic ventral penile swelling during micturition.MethodsIn this series, we report seven such cases of congenital anterior urethral diverticulum treated over a period of 12 years (2008–2020). All cases presented to the Pediatric Surgery Department with dysuria, dribbling of urine, recurrent urinary tract infection, and/or fluctuant ventral penile swelling. They were further evaluated with retrograde urethrography with micturating cysto-urethrogram and cysto-urethroscopy.ResultsThree cases had anterior urethral valves that were managed by cystoscopic fulguration of valves. Surprisingly, all these three cases had concomitant posterior urethral valves, while the other four cases presented with relatively larger and saccular anterior urethral diverticulum required excision of the diverticulum and primary urethral reconstruction.ConclusionsThe cases with congenital anterior urethral diverticulum secondary to anterior urethral valves may also be associated with posterior urethral valves as seen in our case series. Surgeons should be aware of this association, and both valves should be fulgurated in the same sitting. A larger and saccular anterior urethral diverticulum requires excision and urethroplasty as a definitive procedure.

The Outcome of Posterior Urethral Valves among Children in Tertiary Care Hospital–A Prospective Study

Introduction: Posterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction in male children. This obstruction in posterior urethra could lead to severe dilatation of upper urinary tract and functional impairment of one or both kidney. The presentations are not always same for all patients. Early diagnosis and appropriate treatment may reduce the progressive damage and helps in recovery. Aim of the Study: The aim of this study was to find out the presentation and to assess the short term functional outcome after fulgaration of the patients with PUV. Methods: This prospective study was conducted at Pediatric urology department, Bangladesh Shishu Hospital and Institute, Dhaka. We included fifty patients with Posterior urethral valve, who were treated at the pediatric urology department from Jan, 2019 to Nov, 2021. Result: Total 50 patients enrolled in the study. In our study we found 50% of our patients were aged between 1 month to 1 year, followed by 36% were more than 1 years old and 14% were less than 1 month old. 76% patients were presented with dribbling of urine. 40%,26%,10% and 6% patients had UTI, poor stream,, retention of urine and palpable bladder respectively. 45 patients had bilateral hydronephrosis ( HDN) at presentation and only 5 had unilateral hydronephrosis in USG. At follow up MCU, 14% patients had unilateral VUR and 10% patients had bilateral VUR. Mean postoperative serum creatinine was 0.585 mg/dl. We found residual Valve in 11(22%) patients during follow up who required repeat Valve ablation. Conclusion: In our study, we found that Cystoscopic valve ablation and follow up is the treatment of choice for PUV patients which may arrest the progressive damage of renal function and facilitate the improvement. Further multicenter study and long term follow up is necessary for understanding the ultimate outcome.

Foley's Catheter Balloon Avulsion of Posterior Urethral Valve in Children: How Effective?

Background: Endoscopic ablation under direct vision is the gold standard for treatment of posterior urethral valve. However, when the facilities are not available, Foley’s catheter balloon avulsion of the valve suffices. The aim of this study was to evaluate the initial outcome of management of children with posterior urethral valve treated by Foley’s catheter balloon avulsion. Materials and Methods: This was a retrospective study of children, aged 15 years and younger, who were treated for posterior urethral valves at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The parameters evaluated included the age of the patient at presentation, duration of symptoms before presentation, time interval between presentation and intervention, presenting symptoms, procedure performed, post-intervention complications, duration of hospital stay and outcome of treatment. Results: A total of 24 children underwent catheter balloon avulsion during the study period. The mean age of the patients at presentation was 18 months and the mean duration of hospital stay was 18 days. Poor urinary stream and overflow incontinence were the most common presentations of the patients. Twenty-three out of 24 (96%) patients achieved full recovery with marked improvements in urinary stream and resolution of urinary symptoms. Patients who had hydronephrosis and vesicoureteric reflux before treatment, had resolutions of their pathologies during the period of follow up. However, one tenth of the patients each, experienced urethral injury and temporary urinary incontinence. Conclusion: In resource poor settings where the necessary facilities are not available, Foley catheter balloon avulsion of posterior urethral valve is a simple and effective modality of treatment.

Glans Anthropometry for Preputial Reconstruction in Hypospadias.

Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid-penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11-21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33-63 mm). Mean follow-up was 12 months (range: 1-36 months). Mean age at presentation was 23 months (range: 14-72 months). Mean operating time was 50 min (range: 45-60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

Neonatal Posterior Urethral Valves as a cause of Acute Abdominal Distention

Introduction: An 18-day-old term, male presented to the emergency department (ED) for 1-2 days of progressive abdominal distention. Case Report: Over the past week the infant had been spitting more, but it was non-bilious and non-projectile. He had no fevers. On examination, he was ill appearing with a distended abdomen. A flat-plate of his abdomen was obtained that was concerning for possible partial small bowel obstruction, which led to extensive imaging with an upper and lower gastro-intestinal contrast studies that were negative. Ultimately, an ultrasound was performed that revealed marked bladder distention with hydronephrosis. A urinary catheter was placed to relieve his bladder obstruction. Avoiding cystourethrogram confirmed a diagnosis of posterior urethral valves. Conclusion: Posterior urethral valves (PUVs) as a cause of abdominal distention in the neonate is a rare presentation. PUVs have an incidence of 1/4000 male births; of which 1/3rd are detected in-utero, 1/3rd in the first year of life. Most infants with PUVs will present with a urinary tract infection, others present with failure to thrive, poor urine stream and or grunting while urinating. The neonate with acute abdominal distention warrants a thorough and expedited evaluation for possible acute surgical etiologies, such as midgut volvulus due to malrotation. Early identification of bladder obstruction by point of care ultrasound would have helped focus the evaluation and lead to earlier relief of his bladder obstruction. PUVs should be considered on all male infants with urinary tract infection, failure to thrive, poor urinary stream or abdominal distention.