Valve Fulguration Research Articles

Comparison of the Role of Anticholinergics and α-1 Adrenergic Blockers in Bladder Management in Posterior Urethral Valves: A Pilot Randomized Control Trial

Introduction: Posterior urethral valve (PUV) is a major cause of congenital bladder dysfunction, often persisting despite treatment. Emerging therapies, including anticholinergics and α-1 blockers, offer potential but lack clear guidelines. This study evaluates their effectiveness in improving bladder function after valve fulguration. Methods: Twenty PUV patients, aged ≥3 years, were randomized into anticholinergic (group A, n = 11) and α-1 adrenergic blocker (group B, n = 9) groups post-fulguration. Follow-up included clinical, radiological, and urodynamic assessments 6 months posttreatment initiation. Results: In group A, the mean maximum detrusor pressure (Pdet) decreased from 30.17 to 23.45 cm H2O (p = 0.033). Two patients normalized from high detrusor pressure (>40 cm H2O). In group B, 1 patient retained high detrusor pressure posttreatment. Group B improved in average urinary flow (Q avg) and maximum flow rate (Q max), with all patients having initially low Q avg (<10 mL/s). Two group B patients showed improved average flow rates posttreatment (p = 0.016); three in group A showed improvement but were not statistically significant (p = 0.197). Q max/flow time ratio was abnormal in all group B patients pretreatment. Two of the nine improved posttreatment, while only one in group A did. Conclusions: Anticholinergic medications positively impact cystometric parameters and are effective for detrusor instability and low compliance bladder. α-Adrenergic blockers influence uroflow parameters and can help treat bladder outflow obstruction. Consideration for a larger study with extended follow-up is warranted.

The Impact of Consanguinity on Severity of Posterior Urethral Valve

Background: Posterior urethral valve (PUV) is one of the frequent causes of obstructive uropathies at birth. When inadequately managed, it leads to vesicoureteric reflux disease, recurrence of UTIs, voiding disorder and chronic renal insufficiency. These valves have been observed among the siblings, twin children and also in the subsequent generation. However, their occurrence rate and association with consanguineous have never been investigated. Objective: To assess the frequency and impact of kinship on the severity of the posterior urethral valve at our centre. Study Design: A Retrospective Study Place and duration of study: Diagnosed cases of posterior urethral valves who underwent valve fulguration from Jan 2012 to April 2020 were assessed in this study, conducted at Shifa International Hospital, Islamabad. Material and method: Patients were diagnosed via voiding symptoms, ultrasound, and confirmation by VCUG and cystoscopy. In all patients, the history of consanguineous marriage and any history of PUV in the family was inquired. All cases were evaluated for renal function with BUN and creatinine, including eGFR, as per Schwartz's formula. A nuclear scan was performed in all patients to rule out renal scaring and split renal function. Results: The mean age of children who underwent valve fulguration was 4.34 + 2.7 years. Family history of first-degree cousin marriage was found in 56 (33.0%) patients. Statistical analysis of clinical parameters of the posterior urethral valve, including the degree of hydronephrosis, vesicoureteric reflux and chronic kidney disease, showed that the product of cousin marriage had more severe disease. Conclusion: One-third of PUV patients had a history of consanguineous marriages in this study. These cases develop early renal insufficiency as well as a more severe disease. Keywords: Posterior urethral valve, Consanguinity, Severity, Renal insufficiency, Retrospective Study

A case report of Cobb’s collar with posterior urethral valves: a rare entity

BackgroundPosterior urethral valve (PUV) is a congenital disorder typically presenting in the neonatal period and is associated with the obstruction of the urinary tract. Cobb’s collar is congenital narrowing of bulbar urethra in infants. It can lead to significant morbidity, which may include irreversible renal failure if left untreated.Case presentationA 21-month-old child presented with acute retention of urine and distended lower abdomen. His baseline tests were normal. Ultrasound KUB showed grossly enlarged bladder with almost 1100-ml residual urine. Foley’s catheterization attempted but failed. Urgent cystoscopy was planned where congenital anterior urethral stricture with posterior urethral valves was seen. DVIU done for urethral stricture followed by fulguration of posterior urethral valves. The patient was discharged from hospital the next day.ConclusionA congenital narrowing of the bulbar urethra is uncommon. Though it is rare, it can occur concomitantly with PUV. If this double pathology is missed can result in serious consequences. Children with recurrent urinary tract infections should be ruled out for anterior urethral strictures.

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.

Problems in managing the outcome of posterior urethral valves at LRH Hospital

Aim: The goal of this study is to characterise the appearance of posterior urethral valves and evaluate the effectiveness of their treatment in settings with limited medical resources. Methods: The Department of Urology at lrh Peshawar performed a retrospective, descriptive research between Jan 2019 and Jan 2021. The presentation, duration of symptoms, complications, and treatment outcome were all considered. Results: There were 460 patients in total. Approximately three years old was the midpoint [02 days–10 years]. The average time from the onset of symptoms to diagnosis was [2.4 years]. 400 (90%) individuals reported urosepsis; 160 (34%) patients showed unilateral or bilateral reflux; 70 (16%) patients presented with big decompensated bladder, and 80 (18%) patients presented with substantial renal insufficiency. The radiological results verified the presumptive diagnosis of the posterior urethral valve. All patients underwent a cystoscopy and valve fulguration; some underwent further vesicostomy or ureterostomy procedures. Conclusion: According to the study, late presentation is common in our setting. High rates of illness and death are linked to this. The medical community must work toward greater awareness and earlier diagnosis to slow the epidemic.

MANAGEMENT OF POSTERIOR URETHRAL VALVES- A CLINICAL EXPERIENCE FROM INDIAN SETTINGS

Objective: The present study aimed to highlight the current trends in the management of male patients with posterior urethral valves (PUV). Furthermore,thisstudy emphasized clinical, biochemical, and imaging patterns aswell as examined the outcomes of varioustreatment approachessuch as primary valve ablation and vesicostomy to manage PUV. Methods: This prospective clinical study was conducted in department of urology, Kurnool Medical College, Kurnool, AP. A total of 34 PU valve patients with mean age of 2.87 years with at least 6 months of follow-up were included in this study. Data related to demographic details, modes of presentation, diagnostic evaluation, presence of reux, renal status, treatment modalities and follow-up were collected. Surgical procedures included vesicostomy, and valve fulguration. Results: All the patients presented with obstructive voiding symptoms (100.00%), followed by fever with chills and rigors (67.60%) and pyuria (61.76%). Serum creatinine was normal in 13 patients and elevated in 21 patients. In all the cases PUV was diagnosed using MCUG. Overall, 12 (35.29%) patients presented with vesicoureteral reux prior to treatment. Bilateral and unilateral reux was noted in four and eight patients, respectively. Overall, 23 patients underwent primary valve fulguration and 11 patients underwent vesicostomy. In total 80% of patients maintained normal parameters at variable period of follow-up. Conclusion: The present study demonstrated favorable short-term results of primary valve ablation. However, vesicostomy was equally effective in patientswithbilateralhigh-grade reuxorsepsis despitevalve ablationand incircumstanceswhere there istechnicaldifcultyforvalve ablation.

Outcome of boys with posterior urethral valves from a single tertiary hospital in Singapore.

Posterior urethral valve (PUV) is the most common congenital cause of bladder outflow obstruction in male infants. Despite timely treatment, renal damage can still occur in the long-term leading to chronic kidney disease (CKD). A retrospective review of all PUV patients in a single tertiary institution between April 1998 and July 2019 was conducted to analyze their presentations, management and outcomes. Long-term renal function, radiologic scans and somatic growth were evaluated. A total of 16 patients were included in this study. Two patients who defaulted all follow-ups were excluded. Seven patients (43.7%) presented in the antenatal period; four patients (25%) presented in the neonatal period and five patients (31.3%) presented in the post-neonatal period. Primary transurethral fulguration of valves was done in 13 patients, while three had vesicostomies as the primary procedure. Three patients had associated anterior urethral valves (AUV), which were treated endoscopically. Nine boys had additional procedures for diversion and undiversion, VUR, non-functioning kidney and clean intermittent catheterization. Ten patients had urodynamic studies performed, of which eight patients received anticholinergic therapy. Eleven patients had DMSA scans, of which three patients had a normal study and eight patients showed unilateral reduced function. Four patients were diagnosed with CKD on long-term follow-up duration over 5 years. All patients were shown to have good somatic growth. Patients with PUV can suffer from complications despite primary treatment. In our small cohort, a quarter of our patients developed CKD on follow-up. Thus, patients need long-term follow-up to optimize bladder and renal function.

Correlation of Urinary Biomarkers (Interleukin-6, Transforming growth factor-β, E-Cadherin, and MCP-1) with Conventional Parameters of Disease Progression in Patients of Posterior Urethral Valves: A Comparative Analysis.

Posterior urethral valves (PUV) are the leading cause of end-stage renal disease in boys. The study aimed to look at the ongoing renal damage and profibrotic activity by measuring the levels of Interleukin-6 (IL-6), Transforming growth factor-β (TGF-β), E-cadherin, and Monocyte Chemoattractant Protein-1 (MCP-1) and observing trends in subsequent follow-ups and at the same time correlating them with the established parameters of disease progression. This prospective study included 36 consecutive patients of PUV, managed over a period of 18 months. IL-6, TGF-β, E-cadherin, and MCP-1 were measured in urine samples at the time of admission, pre-fulguration and 3 months' and 9 months' post fulguration. The observed values were correlated with the conventional parameters used in clinical practice. All the biomarkers showed statistically significant trends when these values were compared on admission, postoptimization and 3 months' and 9 months' postfulguration. None of the biomarkers showed a significant correlation with renal function tests. E-Cadherin and TGF-β showed a positive and a negative correlation with ultrasonography (USG) kidney, ureter, and bladder (KUB) respectively. E-Cadherin showed a positive correlation, whereas IL-6 and TGFβ showed negative correlation respectively with micturating cystourethrogram (MCUG). IL-6 showed statistically a significant negative correlation with dimercapto succinic acid (DMSA). MCP-1 did not show any significant correlation with USG KUB, MCUG and DMSA. This study concludes that E-Cadherin, IL-6, TGF-β can be promising urinary biomarkers for early detection of the ongoing renal damage in patients of PUV following valve fulguration. MCP-1 may have more complex interactions, with inflammatory markers; which warrants further research.

Clinical profile of children with posterior urethral valve at Tertiary Care Center.

Background & Objective:Posterior Urethral Valves (PUV) are common cause of congenital obstructive uropathy in boys and may be associated with urinary tract infection(UTI) and chronic kidney disease(CKD) if not managed timely. The objective of our study was to determine the clinical profile of children with PUV.Methods:This is a descriptive case series comprising of 30 children aged 1-5 years, diagnosed and managed as PUV over six months, conducted at the Department of Pediatric Nephrology, National Institute of Child Health, Karachi. Patients were followed for 12 weeks and the outcome was assessed in terms of recovery, UTI, urinary incontinence and CKD. Descriptive statics were used for data analysis.Results:Thirty cases of PUV were managed during study period. Clinical presentations were poor urinary stream (83%), fever (73%), signs and symptom suggesting UTI (96.6%), pallor (73.3%), acute kidney injury (37%)and urinary retention (13%). UTI was confirmed in 73.3 % and E.Coli was the most common pathogen. Ultrasonography showed bilateral hydronephrosis/hydroureter in 80% and micturating cystourethrogram demonstrated vesicoureteral reflux in 86.66% cases. All patients received intravenous hydration (97%), urinary decompression, and antibiotics. Meropenem was the most commonly used. Packed cell transfusion and peritoneal dialysis was done in 73.33% and 13.3% respectively. Cystoscopic valve fulguration was done in 86.66% and vesicostomy in 13.3%. On short-term follow-up, 60% recovered,16.66% experienced UTI and remained incontinent whereas 23.33% had CKD.Conclusion:Our study showed a high frequency of UTI and AKI. E. coli was most common pathogen. Despite valve fulgration, significant patients had CKD.

Impact of surgical intervention on progression to end-stage renal disease in patients with posterior urethral valve

BackgroundPosterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care.MethodsThis was a single-center ambispective cohort study carried out over a period of 2 years. Patient data regarding the symptoms, investigations, interventions, secondary complications were recorded and were followed up regularly during the study till either normalization of their creatinine level which was maintained up to one-year post-fulguration (non-CKD) or progression to end-stage renal disease (ESRD) requiring renal transplant. Various clinical factors were then compared between these groups.ResultsThe age of presentation varies from 6 months antenatal period to a maximum of 34 years. Most common symptom was of lower urinary tract obstruction, followed by recurrent febrile UTI. The interval between disease presentation detection and PU valve fulguration ranged from 6 days to more than 5 years, median duration being 1 month. 85.7% patients had hydroureteronephrosis on initial USG. In VCUG, there was no significant difference found between the presence of reflux and poor renal outcome. Age of presentation greater than 2 years was seen in 52% of patients with CKD compared to only 10% patients in non-CKD group (significant, p value 0.02). Among patients who developed CKD, 60% of patients had PU valve fulguration after one month of disease presentation, while in contrast, among the non-CKD group, 80% of patients had it done within one month of disease presentation. (significant, p value 0.03).ConclusionsLate age of presentation, delayed fulguration with high initial creatinine, and failure of serum creatinine to return to normal after one-month post-fulguration are important risk factors in the progression of the disease to ESRD. Symptomatic improvement after interventions does not correlate with progression to ESRD. The number of interventions also does not predict progression to ESRD. Interventions should be chosen wisely on case to restore near-normal physiology and delay progression to ESRD.

Two Cases of Fetal Lower Urinary Tract Obstruction (LUTO) with Similar Presentations Before But Contrasting Outcomes After Fetoscopic Laser Fulguration of Posterior Urethral Valves

Two Cases of Fetal Lower Urinary Tract Obstruction (LUTO) with Similar Presentations Before But Contrasting Outcomes After Fetoscopic Laser Fulguration of Posterior Urethral Valves

Urinary ascites in a neonate with posterior urethral valve

Urinary ascites in a newborn is an extremely rare condition, most commonly due to posterior urethral valves, due to transmission of high intravesical pressure to calyceal fornices, and subsequent urinary ascites either by calyceal perforation or filtration through walls of urinary tract and their rupture. We describe a newborn male baby, who presented with huge abdominal distension at birth, and diagnosed as urinary ascites on paracentesis. Baby was asphyxiated and required resuscitation at birth, and ventilatory support for 4 days in v/o significant abdominal distension. Micturating cystourethrogram (MCUG) and magnetic resonance imaging (MRI) showed posterior urethral valves. Baby also had a left sided urinoma and grade 4 vesicoureteral reflux (VUR) on MCUG. Post paracentesis and drainage of 400ml of ascetic fluid, and urinary catheterization, baby had significant improvement of deranged renal parameters, and diuresis, and could be weaned from ventilation. In v/o inability to negotiate a urethroscope, a vesicostomy was done for urinary drainage and fulguration of valves planned on follow-up.

Effects of oxybutynin in children with posterior urethral valves post fulguration: Report in a select cohort of children

Objectives:Posterior urethral valves (PUV) is the commonest obstructive uropathy with varied consequences. Though valve fulguration is the treatment of choice, appropriate bladder management modifies outcome and includes rational use of anticholinergics. Here, we aim to evaluate the effects of oxybutynin on the bladder and urinary tract morphology and function. Concurrently, we document adverse effects encountered, patient compliance, and medication adherence.Methods:A retrospective study of children below 5 years of age (2012–2017) post fulguration and on oxybutynin for at least 6 months. Patient demographics, clinical features, renal ultrasound, micturating cystourethrogram, dimercaptosuccinic acid scan, adverse effects, and pill count for medication adherence were collated.Results:48 children below the age of 5 years were included, and 12 were excluded either due to the presence of concomitant problems or were not on oxybutynin. Of the 36, four were lost to follow-up and one had died due to an unrelated condition. Thus, a total of 31 children were analyzed. At follow-up, 28/31 patients were asymptomatic, two had daytime incontinence, and one had recurrent urinary tract infection. All patients except one have preserved renal function tests. On ultrasonography, hydroureteronephrosis worsened in only 1/25 children and two showed significant post void residues. The resolution of vesicoureteral reflux was noted in almost 50%. 4/31 renal units had progressive scars. Only two parents defaulted medication. Urodynamic study done in half of these children showed stable bladder pressures except in two.Conclusion:Oxybutynin therapy following adequate valve fulguration aids upper tracts preservation by stabilizing deranged bladder dynamics. The medication is well tolerated with minimal or no side effects.

Outcome of Endoscopic Fulguration of Posterior Urethral Valves (Puv) in Children

Background: Posterior Urethral Valves (PUV) are one of the most common urological problems having wide clinical implications and the prognosis depends upon the extent of the renal injury inflicted by the time of initiation of intervention and hence earlier the treatment, better the long-term outcome Objectives: To evaluate the outcome of endoscopic fulguration of posterior urethral valves (PUV) in children. Method: A cross-sectional analytical study was carried out on 50 male children with posterior urethral valves (PUV) from January 2011 to December 2012 in Dhaka Medical College Hospital, who were treated with endoscopic fulguration and came for routine follow-up. Results: In this series, median age of patients was 2 years ranging from 1 to 12 years. Approximately half of the patients (46.0%) were 2 years. Sixty four percent presented with poor urinary stream, 38.0% presented with straining during micturition. The most common physical finding was palpable bladder 60.0%, UTI was present in 52.0% cases. Proteinuria was found in 46.0% cases, raised serum creatinine was found in 36.0% cases. Electrolyte imbalance was found in 12.0% of cases. Ultrasonogram of KUB showed severe hydronephrosis in 14.0% cases. Voiding cystourethrogram diagnosed PUV in 92.0% of cases. The follow-up period was 24 months. At the end of final follow-up 3 patients remained incontinent. Urinary tract infections were absent in 52.0% cases. Hydronephrosis disappeared in 30.0% cases. Chronic renal failure developed in 6.0% of cases. End stage renal disease was found zero during the follow-up period. Conclusion: Follow-up period of longer duration needed to determine the ultimate outcome of these patients because some of the patients develop ESRD in the long run and ultimately renal transplant is the treatment. Treatment should be performed in higher centers where all the facilities are available. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.8-14

Posterior Urethral Valves (PUV): Experience of Follow up Over 7 years

Objectives: Posterior urethral vale is one of the major common congenital obstructive urethral lesions in male children. Endoscopic fulguration with observation is the treatment of choice for posterior urethral valves (PUV). This prospective study was carried out to assess the outcome of endoscopic fulguration of posterior urethral valves based upon the clinical, radiological and laboratory findings. Methods : The study started in Bangabandhu Sheikh Mujib Medical University Hospital in October 2004 on 50 male children with posterior urethral valves who were treated with endoscopic fulguration and came for routine follow up. Diagnosis was established by voiding cystourethrogram (VCUG) and confirmed by urethrocystoscopic findings.. The patients came for follow up after valve ablation at three months interval up to 1 year, and at six months interval for seven years. Results: Mean age of the patients was 2 years ranging from 1 to 12 years old. At diagnosis mean serum creatinine level ± SD was 90.4±44.8 μmol /litre and it decreased to 58.3±11.4μmol/litre at the end of 7 years follow up. Hydronephrotic changes decreased from decreased from 84% to 2%. Proteinuria decreased from 38% to 4%.Urinary tract infections decreased from 58% to 8% at the end of last follow up. Conclusion: In this study patients improved dramatically following fulguration of posterior urethral valves. But these patients need regular follow up because some of these patients may develop ESRD in the long run. Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.40-43

In-utero posterior urethral valve fulguration – technique, indications and outcome in two children

In-utero posterior urethral valve fulguration – technique, indications and outcome in two children

Posterior Urethral Valve associated with Meconium Ileus: A Case Report

Association of posterior urethral valve with neonatal intestinal obstruction is rare; rarer still is its association with meconium ileus. A 1-day-old male presented with features of neonatal intestinal obstruction. Gastrografin enemas confirmed microcolon and were therapeutic. Later, the neonate developed overflow incontinence and deranged renal functions; micturating cystourethrogram confirmed posterior urethral valve. Cystoscopic valve fulguration was performed after stabilization; outcome was favourable.

Management of Posterior Urethral Valves: An Outcome Analysis of Endoscopic Valve Fulguration

Posterior urethral valves (PUV) constitute the most common infra-vesical urinary obstruction in boys. PUV are often accompanied by severe consequences to the lower and upper urinary tract (LUT, UUT). They also represent a major urological cause for pediatric renal transplantations. Surgical options for primary management invariably aim at abolition of valves. However, temporary urinary diversion may sometimes be a viable alternative, especially in critically ill patients or preterm infants. It was a retrospective, descriptive study which was conducted at the Department of Pediatric Surgery, Rajshahi Medical College from January 2018 to December 2018. All stable patients with the diagnosis of posterior urethral valves were included in the study. Endoscopic valve fulguration was performed in all diagnosed patients using bugbee electrode and an adequate sized cystoscope. The procedure was performed under general anesthesia and the urinary bladder was drained with a suitable size Foley's or silicon catheter for 14days. Patients were discharged from the hospital 48-72 hours after the procedure on oral antibiotics and were advised to come to the outpatient department for follow up visits for a period of 6 months. A total of 84 patients were included in the study. All were males with a mean age of 6.5years ranging from 6 months to 12 years. Sixty five patients were without any diversion while 19 had vesicostomy or ureterostomy already done in our department or somewhere else. Stricture urethra was seen in 5 patients, incontinence of urine was seen in 7 patients, nocturnal enuresis in 15 patients and recurrent urinary tract infection in 19 patients. Chronic renal failure was seen in 4 patients while 16 patients lost the follow up.18 patients had an uneventful recovery. Urethral valve ablation is the definitive treatment of posterior urethral valves. Endoscopic urethral valve fulguration is safe, effective and definitive way of management for posterior urethral valves. Early treatment improves the quality of life and prevents the ongoing renal damage. Early presentation in fetal and neonatal life has worst prognosis due to associated renal dysplasia.&#x0D; TAJ 2018; 31(2): 68-72

Etiology and characteristics of pediatric urethral strictures in a developing country in the 21st century

Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series. The current etiology and clinical features of urethral stricture disease in the pediatric population in the developing world were determined. The data of children with urethral stricture disease, who had undergone treatment in the tertiary center from 2001 to 2017, were retrospectively analyzed. After excluding girls, the database was analyzed for clinical presentation, possible causes of stricture, site and number of strictures, and length of stricture and for previous interventions. Subanalysis was performed for stricture etiology by patient age, stricture length, site, previous treatments, and presentation with paraurethral abscess. A total of 195 boys with strictures were identified. The common causes of pediatric urethral stricture were traumatic (36.9%), iatrogenic (31.8%), and idiopathic (28.7%). The anterior urethra was the location of the stricture in 141 patients (72.3%). Iatrogenic causes (due to catheterization, hypospadias repair, and valve fulguration) accounted for the majority of anterior urethral strictures (61/141 or 43.2%). Younger children had a tendency to have an iatrogenic and idiopathic cause for strictures, whereas older children had a traumatic etiology; 18.6% of strictures in children younger than 10 years were secondary to trauma, whereas 44.9% of the strictures in patients older than 10 years were traumatic in origin. Trauma was the major cause of posterior urethral strictures (53/54 or 98.1%) and was always associated with pelvic fracture. Strictures due to lichen sclerosus or infectious cause were rare (5 patients or 2.6%). The length of strictures was longer in pan anterior urethral strictures (mean: 82.0mm) than that of those due to lichen sclerosus (mean: 42.5mm) and in patients who had undergone previous treatment (mean: 28.7mm). Iatrogenic causes such as catheterization and hypospadias repair account for the majority of anterior urethral stricture disease in the pediatric population, especially the younger age-group. However, as the child grows, there is a gradual preponderance of traumatic urethral strictures, including posterior urethral strictures.

A Study of Percutaneous Antegrade Transvesical Fulguration of Posterior Urethral Valves in Neonates and Infants

A Study of Percutaneous Antegrade Transvesical Fulguration of Posterior Urethral Valves in Neonates and Infants