2002, Number 2
Valves of posterior urethral. Experience in 58 cases
Landa JS, Hernández AG, Zaldívar CJ, Velázquez OJ, Pimentel AA
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Language: Spanish
References: 16
Page: 95-104
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ABSTRACT
Obstructive uropathy that takes to the renal failure with more frequency in pediatric age is secondary to valves of posterior urethral valves. the management has changed in important form in last years and prenatal diagnosis has improved the opportune detection of these patients.Material and methods. From January of 1983 to March of 1999, by means of a descriptive and retrospective survey the charts were revised of patient with posterior urethral valves (PUV). The studied variables were: age, renal function, clinical square, associate anomalies, treatment, complications and results. Patients were categorized according to the approach described by Churchill in the groups favorable and unfavorable, with relationship to renal function, including answer of the seric levels of azoados after the temporary relief of the obstruction by means of transurethral probe and to anatomical and functional state of the urinary tract or renal dysplasia.
Results. Fifty eight charts were revised about patients with diagnosis of PUV, age range was since newborn until the 5 years of age, with a 3.7 year-old stocking. Clinical Square was presented mainly as urinary obstruction in smaller than one year and like an urinary tract infection in bigger than this age. Fifteen per cent had associate anomalies, among those that highlighted the cryptorchidism, occlusion duodenal and trisomy 21. In all cases cystorethrogram corroborated characteristic lesion of PUV. Total of 9 patients (15%) corresponded to favorable group, being all these, bigger than a year of age. Forty nine children (85%9 corresponded to unfavorable group. When evaluating the urinary tract it was in 47 patient bilateral hydronephrosis and in 11 unilateral hydronephrosis. Thirty six patients (62%) presented vesicoureteral reflux (VUR), being in 28 bilateral cases and in 8 unilateral. In 2 cases reflux associated to hypertrophied bladder of diminished capacity. Resection of valves was carried out by means of 2 methods: 1. Forced rupture with probe was practiced in 6 patients, corresponding to the oldest cases. 2. Transurethral endoscopic resection or trouhg the vesicostomy was made in 52 patients. Of the 51-transurethral resections, 4 developed urethral stenosis and were subjected to dilations; one of them required internal urethrotomy. Forty per cent of patients with VUR improved or they were solved with resection of the valves and 60% they underwent vesicoureteral reimplantation. In 2 patients with severe vesicoureteral reflux and hypertonic bladder were practiced reimplantation of one of the ureteres and increase ureterocystoplasty.
Discussion. Appropriate treatment of patients with PUV, resides in a series of requirements that include: 1. Opportune diagnosis, of being possible prenatal. 2. Use of fine endourologic equipment of being possible under videoassistance. 3. Patient’s categorization for groups presage that allows to values the functional renal evolutions and therapeutic result. 4. Study of dynamics vesical function. In our experience ideal treatment was primary transurethral resection in newborn period or to the moment of diagnosis. The VUR of low degree showed the same as in other series a marked tendency to dissapear spontaneously after having alleviated obstruction. In those patients with important reflux or some other considerable alteration of upper urinary tract, will think, besides the primary resection, in temporary derivation by means of vesicostomy. This can also be used as anterograde road access for resection of valves, avoiding the risk of urethral damage; overalls when it is not had the appropriate endourologic equipment. According to reached renal improvement, you will proceed to the later desderivation with previous progressive hydraulic dilation of bladder, ureterovesical reimplantation and in ocassion’s augmentation cystoplasty.
Conclusion. Patient’s boarding with PUV will be individualized, taking into account importance of obstruction alleviating promptly with modifies the hopeless destination partly toward the renal failure that have some of these patients.
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