Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction
which could progress to renal damage, Clinical presentation varies according with
patient's age and severity of obstruction, but, in most cases, diagnosis is based
on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic
ablation even if approved guidelines about the overall management of AUVs, including
the recognition and treatment of residual valves, are not available.
We describe our protocol for AUV treatment based on primary endoscopic valve ablation
followed by check cystoscopy 15 days later.
Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric
Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and
VCUG were performed in all children, while urodynamic evaluation was performed in
the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves
ablation and after 15 days after a second look cystoscopy was performed. Follow up
was based on clinical and radiological evaluation with US, urinalysis and blood tests.
Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained
patients and VCUG was performed in 1/5 patient.
and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile
urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra
in another case. In 3/5 patients check cystoscopy found residual valves and a second
endoscopic ablation was performed. All patients achieved symptoms release and improved
urodynamic parameters. No intra or post-operative complication were reported. The
assessment of residual valves is variable in literature and it is usually described
for posterior urethral valves (PUVs). Few series report the use of VCUG within the
first week after valve ablation, our experience instead suggests that performing a
second look cystoscopy, is very effective to evaluate the presence of residual AUVs
and eventually proceed with further ablation.
Endoscopic ablation is the gold standard treatment for AUV, but residual valves management
is not clearly defined. According to our experience, a check cystoscopy 15 days after
primary ablation allows to identify and treat possible residual valves showing good
results in terms of safety and efficacy.