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.
References
[1]
Donohoe, J.M., Weinstein, R.P., Combs, A.J., Misseri, R., Horowitz, M., Schulsinger, D., et al. (2004) When Can Persistent Hydro-Ureteronephrosis in Posterior Urethral Valve Disease Be Considered Residual Stretching. Journal of Urology, 172, 706-711. https://doi.org/10.1097/01.ju.0000129139.10189.3f
[2]
Baunin, C., Puget, C. and Gafsi, R. (1997) Troubles Mictionnelsrévélateurs de valves de l’urètrepostérieu: Aspects radiologiques. Archives de Pédiatrie, 4, 14s-18s.
https://doi.org/10.1016/S0929-693X(97)86436-6
[3]
Perks, A.E., Mac Neily, A.E. and Blair, G.K. (2002) Posterior Urethral Valves. Journal of Pediatric Surgery, 37, 1105-1107. https://doi.org/10.1053/jpsu.2002.33886
[4]
Narasimhan, K.L., Chowdhary, S.K., Kaur, B., Mittal, B.R. and Bhattacharya, A. (2006) Factors Affecting Renal Scarring in posterior Urethral Valves. Journal of Pediatric Urology, 2, 569-574. https://doi.org/10.1016/j.jpurol.2005.12.003
[5]
Abbo, O., Bouali, O., Ballouhey, Q., Mouttalib, S., Lemandat, A., Decramer, S., et al. (2013) Impact de l’age au diagnostic sur le devenir à long terme des patients opérés de valves de l’urètre postérieur. Progrès en Urologie, 23, 144-149.
https://doi.org/10.1016/j.purol.2012.10.015
[6]
Khemakhem, R., Ben Ahmed, Y., Mefteh, S., Jlidi, S., Charieg, A., Louati, H., et al. (2012) Les valves de l’urètre postérieur: A propos de 38 cas. Journal de Pédiatrie, 1-7.
[7]
Davody, A.P., Amaro, J.W. and Cukier, J. (1992) Les valves de l’urètre postérieur chez le nouveau-né et le nourrisson: traitement et évolution. Progrès en Urologie, 2, 901-907.
[8]
Van Glabeke, E., Philippe-Chomette, P., Montagne, J.P., Audry, G. and Gruner, M. (1997) Intérêt de la néphrostomie percutanée dans la prise en charge des valves de l’urèthre postérieur chez le nouveauné. Progrès en Urologie, 7, 996-1001.
