POSTERIOR URETHRAL VALVES

A Study of the Sequelae after the Valve Ablation

Abstract

A study of the upper and lower urinary tracts was undertaken in 41 boys with posterior urethral valves with regard to the radiological and functional changes after the valve ablation. All valvular structures were endoscopically confirmed as Young's Type I, and were incised with a miniature resectoscope.
The results indicates:
1) Vesicoureteral reflux was observed on 27 ureters in 16 boys (39%). Reflux stopped spontaneously after valve incision in 13 ureters (48%). There was apparent correlation between the age of operation and the spontaneous cessation of reflux. In 6 boys who were operated on under 1 year, all reflux was cured or improved.
Ring ureterostomy was made on 5 ureters. On 9 ureters, which remained unchanged after TUR, antireflux surgery was performed. Reflux recurred in 3 ureters. Nephroureterectomy was done on one renal unit with persistent massive reflux. The kidney had no function on routine examination, and the histology revealed renal dysplasia.
2) Prevesical ureteral stenosis was observed in 13 ureters in 10 boys (24%). In 6 ureters, ureteral dilatation improved after TUR. Among 6 boys who were operated on under 3 year of age, hydroureteric changes decreased in six of 9 ureters. Although ureterocystoneostomy was made on 4 ureters, three ureters remained dilated after the operation.
3) There were six boys with decreased renal function. Two patients with ESRD underwent hemodialysis.
4) Fourteen boys (35%) complained urinary incontinence after relief of obstruction. Enuresis nocturia continued in 10 boys, daytime incontinence in 10 boys. Two boys did not tell any sensation of bladder fullness even after they began to go to school. All boys who were treated on bladder neck either by TU-resection or Y-V plasty were incontinent. There was no relationship between the age of valve ablation and symptoms of urinary control.
5) Urodynamic assessment after the TUR was made on 13 boys, most of which complained abnormal voiding. Of the boys, seven showed hypertonic pattern on cystometry. The bladder of these children was severely trabeculated before the operation of obstructive valves. Five boys, who were evaluated after ureteral reimplantation, revealed severe hypertonic, low complianced bladder. Unihibited bladder contraction was apparent in 7 boys. High incidence of uninhibited contraction in this series suggests that congenital outlet obstruction may be one of the possible factors of this functional bladder dysfuction.