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Posterior urethral valve

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Abstract

Background

Posterior urethral valve (PUV) is a significant cause of morbidity, mortality and ongoing renal damage in children. It accounts for end-stage renal disease in a proportion of children. This article aims at highlighting the current trend in the management of boys with posterior urethral valve.

Data sources

PubMed/Medline and bibliographic search for posterior urethral valve was done. Relevant literatures on presentation, pathology, evaluation, management and outcomes of PUV were reviewed.

Results

PUV which is increasingly diagnosed prenatally presents a spectrum of severity. The varied severity and degree of obstruction caused by this abnormality depend on the configuration of the obstructive membrane within the urethra. The decision to intervene prenatally is dependent on gestational age, amniotic volume, and renal function of fetal urine aspiration. Identification of the patients who may benefit from early intervention remains inconclusive. Endoscopic ablation of the valve is the gold standard of treatment but use of Mohan’s valvotome and other modalities are invaluable in developing countries where endoscopic facilities are limited. Proximal urinary diversion may result in poor bladder compliance and should be reserved for patients with persisting or increasing upper urinary tract dilatation, increasing serum creatinine or inappropriate instruments. The behavior of the bladder and its subsequent management after valve ablation may influence the long-term renal outcome in PUV patients.

Conclusions

The care of children with PUV continues to improve as a result of earlier diagnosis by ultrasound, developments in surgical technique and meticulous attention to neonatal care. The ultimate goal of management should be to maximize renal function, maintain normal bladder function, minimize morbidity and prevent iatrogenic problems.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria

    Abdulrasheed A. Nasir, Lukman O. Abdur-Rahman & James O. Adeniran

  2. Division of Pediatric Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

    Emmanuel A. Ameh

  3. Department of Pediatric Surgery, Amrita Institute of Medical Sciences and Research centre, Kochi, India

    Mohan K. Abraham

  4. Division of Paediatric Surgery, Department of Surgery, University of Ilorin Teaching Hospital, PMB 1459, Ilorin, Nigeria

    Abdulrasheed A. Nasir

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  1. Abdulrasheed A. Nasir
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  2. Emmanuel A. Ameh
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Correspondence to Abdulrasheed A. Nasir.

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Nasir, A.A., Ameh, E.A., Abdur-Rahman, L.O. et al. Posterior urethral valve. World J Pediatr 7, 205–216 (2011). https://doi.org/10.1007/s12519-011-0289-1

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  • DOI: https://doi.org/10.1007/s12519-011-0289-1

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