A study proposal on short term outcome and prognosis of primary and delayed fulguration in posterior urethral valve

Jeevarathi T., Gomathi Vadivelu


Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male neonates. The incidence is 1 in 4000, 1 in 7500 births PUV occur exclusively in males. This disease has a broad spectrum of presentations. They may present at any age during childhood and may vary from ascites in the neonate to renal failure in infants and only minor voiding dysfunction in an older child. Urinary tract infection is common at all ages. The objectives of the study were to assess the impact of primary impaction on short term outcomes and to assess the outcome of diversion and delayed fulguration.

Methods: This retrospective study was conducted at the Pediatric Urology outpatient department (OPD) at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai including the patients who attended the pediatric surgery from August 2008 to December 2011.

Results: In the current series, the incidence of renal insufficiency in patients with urosepsis was 45%. Recurrent urosepsis >3 episodes in a year (fever with urine culture showing infection) primarily due to poor patient compliance lead to progressing pyelonephritis and nephron damage and plays an important role in the outcome of these children.

Conclusions: The incidence of renal insufficiency in children with posterior urethral valves in this series was 38% (30-45%) with an average follow up 3 years. Several factors were important in prognosticating the progression towards renal insufficiency and bladder dysfunction. Urodynamics is of immense help in cases having symptoms despite good stream. The use of anticholinergic for abnormal urodynamics gives encouraging results.



Short term outcome, Prognosis of primary, Delayed fulguration, Posterior urethral valve

Full Text:



Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F. ItalKid Project. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003:111:382-7.

Atwell JD. Posterior urethral valves in the British Isles: a multicenter B.A.P.S review. J Pediatr Surg. 2003;18(1):70-4.

Bajpai M, Dave S, Gupta DK. Factors affecting outcome in the management of posterior urethral valves. Peditr Surg Int. 2001;17:11-5.

Bernardes LS, Aksnes G, Saada J, Masse V, Elie C, Dumez Y, et al. Keyhole sign: How specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol. 2009;34:419-23.

Caione P, Nappo S. Posterior urethral valve. In: Puri P, Höllwarth M (eds). Pediatric surgery: diagnosis and management. Springer, Berlin Heidelberg. 2009;863-79.

Ansari MS, Singh P, Mandhani A, Dubey D, Srivastava A, Kapoor R, et al. Delayed presentation in PUV- long term implication & outcome. J Urology. 2008;71(2):230-4.

Dewan PA, Zappala SM, Ransley PG, Duffy PG. Endoscopic reappraisal of the morphology of congenital obstruction of the posterior urethra. Br J Urol. 1992:70(4):439-44.

Dinnen MD, Dhillon HK, Ward H. Posterior urethral valve. Br J Urol. 1993;72:364-9.

Hendren WH. Posterior urethral valves in boys a broad clinical spectrum. J Urol. 2011:106(2):298-307.

Hoover DI, Duckett J. Posterior urethral valve – VURD syndrome. J Urol. 1992;128:994-6.

Hutton KA, Thomas DF, Davies BW. Prenatally detected posterior urethral valves: Qualitative assessment of second-trimester scans and prediction of outcome. J Urol. 1997;158:1022-5.

Pereira L, Urrutia MJ, Jaureguizar E. Initial and long-term management of posterior urethral valves. World J Urol. 2004;22:418-24.

Mahony BS, Callen PW, Filly RA. Fetal urethral obstruction: US evaluation. Radiology. 1985;157:221-4.

Management of PUV on basis of urodynamics findings. J Urol. 1994;158(3):1011-6.

Parkhouse HF, Wardhouse CR. Long term outcome of patients with UV. J Urol Clinics North America.1990;17:373-8.

Parkhouse HF, Barratt TM, Dhillon MJ, Duffy PG, Fay J, Ransley PG, Woodhouse CR, Williams DI. Long-term outcome of boys with posterior urethral valves. Br J Urol. 1998;62(1):59-62.

Peters CA, Bolkier M, Bauer SB, Hendren WH, Colodny AH, Mandell J, Retik AB. The urodynamic consequences of posterior urethral valves. J Urol. 2001;144(1):122-6.

Warshaw BL, Hymes LC, Trulock TS, Woodard JR. Prognostic features in infants with obstructive uropathy due to posterior urethral valves. J Urol. 1985;133(2):240–3.

Hendren WH. Posterior urethral valve in boys a broad clinical spectrum. J Urol. 1998;106:1477-81.

Rittenberg MH, Hulbert WC. Protective factors in posterior urethral valves. J Urol.1988;154:708-11.