Concomitant Anterior and Posterior Urethral Valves: An Uncommon Association

Sobh A1, Elkashef A1, Hussiny M1, Anas M1, Helmy T1

Research Type

Clinical

Abstract Category

Paediatrics

Abstract 68
Paediatrics and Nocturia
Scientific Podium Short Oral Session 9
Wednesday 27th September 2023
16:27 - 16:35
Room 104CD
Pediatrics Male Voiding Dysfunction Surgery
1. Department of Urology, Urology and Nephrology Center, Mansoura University, Egypt
Presenter
Links

Abstract

Introduction
Posterior urethral valves (PUV) are considered the most common cause of infravesical obstruction in boys, while anterior urethral valves (AUV) are less commonly encountered. Concomitant AUV and PUV has been reported to be uncommon, so it may be missed during the initial evaluation. Herein, we demonstrate a video-case illustrating a step-by-step surgical management of concomitant AUV and PUV.
Design
This video shows the diagnostic and surgical approach for a 2-day old boy who was presented with poor urine stream, bilateral antenatal hydronephrosis and high serum creatinine (2.1 mg/dl). He underwent renal and bladder ultrasonography (RBUS) that showed bilateral grade IIa hydronephrosis with dilated upper and lower ends of both ureters and thick-walled urinary bladder with minimal amount of urine inside. Voiding cystourethrogram (VCUG) was ordered and showed right GV vesicoureteral reflux (VUR), highly positioned urinary bladder, dilated both anterior and posterior portions of the urethra. Cystoscopy was done and revealed leaflets of PUV at 5,7 and 12 O'clock, AUV at 6 O'clock, hypertrophied bladder neck and trabeculated bladder mucosa. Endoscopic valve ablation using wolffian knife was done at 7, 5, 6 and 12 O'clock, respectively, followed by bladder neck incision at 6 O'clock.
Results
At the end of the procedure, patent urethra was noted with no evidence of any residual obstruction. By manual compression on the urinary bladder, good flow of urine was observed. The urethral catheter was kept indwelling for 2 days, and after removal of the urethral catheter, the patient voided well. Serum creatinine dropped to 1.3 mg/dl. No fever or abdominal distention was encountered.
Conclusion
Association of AUV and PUV is uncommon but it occurs, so it should not be missed during radiological and cystoscopic evaluation.
Disclosures
Funding There is no funding source Clinical Trial No Subjects Human
Citation

Continence 7S1 (2023) 100786
DOI: 10.1016/j.cont.2023.100786

16/10/2024 22:17:09