medigraphic.com
Órgano Oficial de el Colegio Mexicano de Urología

2002, Number 1

<< Back Next >>

Bol Col Mex Urol 2002; 17 (1)

Comparative study of different primary treatments of patients with posterior urethral valves. Nine years experience

Guerra CVV, García de León GJM, González POP

Language: Spanish
References: 17
Page: 7-12
PDF size: 103.40 Kb.


ABSTRACT

There are three different forms of primary treatment of the posterior urethral valve (PUV): valve ablation, vesicostomy and proximal urinary diversion. The most appropriate primary treatment that less jeopardize bladder and renal function remains controversial. We report our experience comparing the incidence of development of chronic renal failure, (CRF), valve bladder and the number of surgeries required between the different primary treatments. The reports of 70 patients treated and with follow-up at our institution were reviewed. We divided the patients in 3 groups according to the primary treatment: primary valve ablation (n = 27), vesicostomy (n = 37) and proximal diversion (n = 6). The prognosis (Churchill’s criteria) was favorable in 42 patients and unfavorable in 28. The average follow-up was 9 years. The prevalence of CRF on the time of diagnostic was 23%; the incidence of CRF during follow-up was 14%, there was no statistic difference (p › 0.05) between the three groups. Forty-nine boys (70%) developed valve bladder, 90% hyperreflexia and 10% hyporreflexia. There was no statistic difference between the groups on the development of valve bladder. Half of the boys in the valve ablation group did not require any open surgery, in contrast to the other groups that all the boys needed at least one open surgery (p ‹ 0.05). We conclude that primary valve ablation is the best treatment because it’s the definitive procedure, it’s safety to bladder and renal functions, and it’s the treatment that will require less subsequent surgeries.


REFERENCES

  1. González ET. Valva uretral posterior y otras anomalías de la uretra. En: Walsh PC, Retik AB, Stamey ThA, Vaughan ED, Campbell Urología. 6ta. Edición. Edit. Panamericana 1994.

  2. González ET. Alternatives in the management of posterior urethral valves. Urol Clin North Am 1990; 17(2): 335-42.

  3. Churchill BM, McLorie GA, Khoury AE, Merguerian PA, Houle AM. Emergency treatment and long-term follow-up of posterior urethral valves. Urol Clin of North Am 1990; 17(2): 343-60.

  4. Smith GHH, Canning DA, Schulman SL, Snyder HM, Duckett JW. The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol 1996; 156: 1730-4.

  5. Dixon WR, Padron M. The management of posterior urethral valves by initial vesicostomy and delayed valve ablation. J Urol 1990; 144: 1212-4.

  6. Posterior urethral valves-new concepts (editorial). J Urol 1997; 157: 996-7.

  7. Casale AJ. Early ureteral surgery for posterior urethral valves. Urol Clin North Am 1990; 17(2): 361-72.

  8. Tietjen DN, Gloor JM, Husmann DA. Proximal urinary diversion in the management of posterior urethral valves: is it necessary? J Urol 1997; 158: 1008-10.

  9. Reinberg Y, De Castano I, Gonzalez R. Influence of initial therapy on progression of renal failure and body growth in children with posterior urethral valves. J Urol 1992; 148: 532-3.

  10. Parkhouse HF, Barratt TM, Dillon MJ. Long term outcome of boys with posterior urethral valves. Br J Urol 1988; 62: 59-62.

  11. Parkhouse HF, Woodhouse CRJ. Long-termástatus of patients with posterior urethral valves. Urol Clin North Am 1990; 17(2): 373-78.

  12. Reinberg Y, De Castano I, Gonzalez R. Prognosis for patients with prenatally diagnosed posterior urethral valves. J Urol 1992; 148: 125-6.

  13. Connor JP, Burbige KA. Long-term urinary continence and renal function in neonates with posterior urethral valves. J Urol 1990; 144: 1209-11.

  14. Peters CA, Bauer ST. Evaluation and management of urinary incontinence after surgery for posterior urethral valves. Urol Clin of North Am 1990; 17(2): 379-87.

  15. Kim YH, Horowitz M, Combs AJ, Nitti VW, Borer J, Glassberg KI. Management of posterior urethral valves on the basis of urodynamic findings. J Urol 1997; 158: 1011-6.

  16. Close CE, Carr MC, Burns MW, Mitchell ME. Lower urinary tract changes after early valve ablation in neonates and infants: is early diversion warranted? J Urol 1997; 157: 984-8.

  17. Kim YH, Horowitz M, Combs A, Nitti VW, Libretti D, Glassberg KI. Comparative urodynamic findings after primary valve ablation, vesicostomy or proximal diversion. J Urol 1996; 156: 673-6.




2020     |     www.medigraphic.com