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.
The posterior urethra valves (PUV) are the main cause of congenital obstruction in the body [
The purpose of this work was to report our diagnostic approach and to evaluate the management of PUV at the surgical medical Centre of urology.
This was a descriptive retrospective study reviewing 12 records of patients carrying PUV and taken over at the surgical medical Centre of Urology (MSCU) in Cameroon at Douala, from January 2011 to December 2016. Patients were either referred by confreres or consulted spontaneously. Were included patients whom the clinical and paraclinical examinations had allowed to retain the diagnosis of PUV and benefited a management. The variables studied were clinical, paraclinical, therapeutic and evolutionary. Clinical variables were: Age, Consultation reason, weight, temperature, general condition, abdominal distension, flowmetry. Paraclinical variables were done for all patients concerned with: blood count, urea and serum creatinine, ultrasound of the urinary tract, urethrocystography and renal scintigraphy. The therapeutic variables were: endoscopic incision at 12 hours then 5 h and 7 h, vesicostomy, iterative urethral dilation, and double J catheterization. The evolutionary variables were: regular checking up of patients in external consultation with the completion of an ultrasound of the urinary tree each month for 6 months, aureterocystography, a urine examination and urea and creatinine serum at 3 and Six months. The favorable evolution was pronounced on the basis of the standardization of the Biological constants, the absence of the valves to the urethrocystography of control and the improvement of the clinical signs.
In 5 years, we had diagnosed and treated 12 cases of posterior urethral valves either an average of 2.4 per year. The average age of patients was 41.6 months with extrems ranging from 3 to 156 months. The reason for consultation was dominated byurinary trac infections. Flow-metry performed in 5 patients had objectified dysuria with a platefull plot. Ultrasound of the urinary shaft had made it possible to suspect the diagnosis in all the patients and also urethrocystography had confirmed this diagnosis by objectifying 4 cases of vesico-uretals reflux including a grade 4 (
The valves of the posterior urethra constitute the most frequent congenital obstructive pathology of the little boy. Its incidence is 1/8000 to 1/25,000 births [
The clinical manifestations are diverse and varied: urinary tract infections, voiding disorders, respiratory disorders, digestive disorders, abdominal distension, stunting in the form of harmonious dwarfism. Our study yield a predominance of urinary tract infections as also noted in other studies [
Due to its non-invasiveness, antenataleechography has made it possible to suspect of PUV pathologies in 3 cases. Despite adequate management of patients, we recorded 5 cases of death. According to the literature, PUV diagnosed early are poor prognosis in relation to the severity of the cervical obstruction [
Urethrocystograhpy retrograde permit us to confirm the diagnosis of PUV, to investigate the complications such as the ureterohydronephrose observed in all patients and the reflux Vescico-ureteral whose presence is a factor of bad prognosis When it is high grade [
For a long time, the treatment of PUV used the iterative lamination of the urethra by increasing urinary catheters [
After 6 months of follow-up after treatment, a favorable evolution noted in 7 patients who were subsequently entrusted to a fellow renal-pediatrician. During the follow-up period, we recorded 5 deaths, all in young patients under 3 years of age, which testifies the severity of obstructive character of the PUV. These deaths are related to the obstructive character of PUV, sepsis, and renal function degradation.
Posterior urethra valves are rare congenital obstructive pathology. Clinical manifestations are several and varied. The endoscopic incision remains the gold standard of the treatment. The vesicotomy is an alternative in the absence of adequate technical platform. Despite early and optimal take cares, the prognosis remains fraught with morbidity and significant mortality.
Kamadjou, C., Rimtebaye, K., Eyongeta, D., Kameni, A., Kamga, J. and Njinou, B. (2018) Management of the Valves of the Posterior Urethra in Urology. Open Journal of Urology, 8, 166-170. https://doi.org/10.4236/oju.2018.85017