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Anterior Urethral Valves: Not Such a Benign Condition…  [PDF]
Omar Cruz-Diaz,Anahi Salomon,Eran Rosenberg,Juan Manuel Moldes,Francisco de Badiola,Andrew Scott Labbie,Rafael Gosalbez,Miguel Alfredo Castellan
Frontiers in Pediatrics , 2013, DOI: 10.3389/fped.2013.00035
Abstract: Purpose: 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 (PUVs). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV, with less hydronephrosis, and a lower incidence of chronic renal insufficiency (5 vs. 30%). The long-term prognosis of AUVs is not clear in the literature. In this report we describe our experience and long-term follow up of patients with anterior urethral valve.
Management of the Valves of the Posterior Urethra in Urology  [PDF]
Cyril Kamadjou, Kimassoum Rimtebaye, Divine Eyongeta, Annie Kameni, Justin Kamga, Bertin Njinou
Open Journal of Urology (OJU) , 2018, DOI: 10.4236/oju.2018.85017
Abstract: Aim: Describe the clinical, radiological and management of patients with posterior urethral valves. Materials and Methods: This was a retrospective descriptive study over a period going from January 2011 to December 2016, reviewing 12 cases of patients treated for valves of the urethra posterior to the medical surgical center of urology in Cameroon at Douala. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Results: In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves, an average of 2.4 per year. The average age of patients was 41.6 months with extrems of 3 and 156 months. The reason for consultation was dominated by urinary tract infections. Urethrocystography and echography were performed in all patients and allowed to objectify a bilateral ureterohydronephrosis, a diverticular bladder in 9 cases and 4 cases of vesico-ureteral reflux, including a grade 4 according to the classification of Cendron, 8 patients suffered from acute urinary failure. Renal scintigraphyrealised on 3 patients had as objective in 1 patient the existence of a disfunctioning kidney. The treatment consisted of an endoscopic incision of the valves (n = 8), a vesicostomy (n = 3) and an iterative urethral dilatation with double J catheter placement (n = 1). The evolution was favorable (n = 7), and 5 cases of death were recorded. Conclusion: The endoscopic incision is the gold-standard of the treatment of the valves of the posterior urethra. The vesicostomy is an alternative in the absence of adequate technical platform. Despite adequate support, the prognosis remains burdened with significant mortality.
Anterior urethral valves associated with hypospadias  [cached]
Mahajan J,Ojha Sunita,Rao KLN
Journal of Indian Association of Pediatric Surgeons , 2007,
Abstract: An association of coronal hypospadias with meatal stenosis and anterior urethral valves is described in this report. A combination of double obstruction in anterior urethra may overshadow the expression of proximal one.
Congenital anterior urethral valves and diverticula: Diagnosis and management in six cases
Rawat Jiledar,Khan Tanvir,Singh Sarita,Maletha Madhukar
African Journal of Paediatric Surgery , 2009,
Abstract: Background: Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. Results: The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. Conclusion: We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.
Primary Realignment of Posterior Urethral Rupture  [cached]
Mehdi Salehipour,Abdolaziz Khezri,Rashid Askari,Parham Masoudi
Urology Journal , 2005,
Abstract: Introduction: We report the results of treatment of posterior urethral rupture (PUR) by primary realignment with some modifications of the technique. Materials and Methods: In this prospective study, 25 patients (mean age, 33.5 years; range, 18 to 70 years) in whom PUR had been proved underwent primary urethral realignment. All patients were evaluated postoperatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed for a mean of 20 months (range, 9 to 27 months). Results: In 20 of 25 patients (80%), posterior urethral rupture was associated with pelvic fractures and in 2 (8%), bladder rupture also was present. None of the patients had urinary incontinence. Six patients (24%) had evidence of postoperative stricture that required urethral dilatation and/or direct vision internal urethrotomy in 2 or 3 procedures under local anesthesia. Erectile dysfunction (which all responded to sildenafil) was reported by 4 patients (16%) as a decreased quality of erection. Conclusion: We believe that primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries.
Delayed primary realignment of posterior urethral rupture
OB Shittu, LI Okeke, TB Kamara, SA Adebayo
West African Journal of Medicine , 2003,
Abstract: The treatment of acute posterior urethral rupture is controversial. Twelve patients who presented with acute posterior urethral rupture over a five--year period were treated by delayed primary realignment of the injury. The technique of this procedure and the outcome are the subject of this presentation. Eight patients had successful realignment without strictures. Two patients with strictures responded to simple dilatations with bougies and the other two had formal urethroplasty.
Posterior Urethral Obstructing Membrane in a Nigerian Neonate, a True presentation of posterior urethral valve- A Case Report
A Eighemhenrio
East and Central African Journal of Surgery , 2012,
Abstract: Posterior urethral valve is the commonest cause of lower urinary tract obstruction in male neonates. Diagnosis can be made prenatally and in newborn males. Young classified posterior urethral valve into three types with Type I having the highest incidence of 95%. Recent findings have shown that Type III appears to actually be the commonest type before catheterization presupposing that Young’s classification was done after atherization. The commonest form of presentation therefore appears to be Type III before catheterization.
Posterior urethral calculi in patients without anatomical abnormalities: Case report  [PDF]
?mer Faruk Karata?,?mer Bayrak,Ersin ?imentepe,Do?an ünal
Medical Journal of Bakirk?y , 2008,
Abstract: Urethral calculi are uncommon problem in urological practice. The incidence of these stones is reported to be lower than 0.3% in the literature. The majority of urethral calculi originates from upper urinary tract or bladder and migrates into the urethra. Native forms are generally associated with postsurgical changes or anatomic abnormalities such as strictures and urethral diverticula. In this paper, we discussed posterior urethral stones in three patients without any urethral anatomic abnormality who were admitted to our clinic over a period of 5 years.
A Neglected Case of Massive Urinary Ascites Secondary to Posterior Urethral Valve: A Developing World’s Scenario  [PDF]
Kanchan Kayastha,Bilal Mirza
Journal of Neonatal Surgery , 2012,
Abstract: Developing countries are not only lagging behind in health facilities but also literacy of the population. Many uneventfully manageable conditions use to present after complications have been occurred. Negligence of the poor people and their blind faith on the fraudulent quacks and peers add burden to the poor health facilities in the resource poor countries. This could be one of important reasons of higher mortality rate in our hospitals especially in neonates with poor reserves to combat these crises for long. Urinary ascites due to in-utero bladder perforation secondary to posterior urethral valves is a rare entity. This condition is being prevented in developed countries by Fetendo which involves decompression of the urinary bladder by vesico-amniotic shunting or by endoscopic in-utero valve ablation. For instance if bladder perforation has occurred, it can be amenable to drainage of urinary ascites with valve ablation. However, we received a delayed presenting case of in-utero bladder perforation with massive urinary ascites secondary to posterior urethral valve necessitating urgent intervention.
Supracrural Rerouting as a Technique for Resolution of Posterior Urethral Disruption Defects  [cached]
Seyed Jalil Hosseini,Alireza Rezaei,Mojtaba Mohammadhosseini,Iraj Rezaei
Urology Journal , 2009,
Abstract: Introduction: Selection of an acceptable method for the treatment of posterior urethral disruption defects would be highly desirable. We determined the efficacy and success rate of some techniques including supracrural rerouting for removing of these defects among our patients. Materials and Methods: Records of 200 consecutive men treated with anastomotic urethroplasty for traumatic posterior urethral strictures were reviewed at our teaching hospital. Prior treatment, surgical approach, and ancillary techniques required during reconstruction were evaluated. Results: Success rate due to posterior urethral reconstruction was achieved in 78.0% of cases. Supracrural urethral rerouting was performed in 11 patients (5.5%), of whom 7 sustained recurrent stricture requiring intervention. The highest success rate of defect resolving was reported by urethral mobilization (92.4%). Conclusion: Supracrural rerouting is not an acceptable technique and can result in postoperative complications such as recurrent stricture in most of the patients with posterior urethral disruption defects.
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