Advertisement

Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves

  • P. Menon
    Correspondence
    Correspondence to: Prema Menon, Room No. 3103, Level 3-A, Department of Pediatric Surgery, Advanced Pediatrics Centre, P.G.I.M.E.R., Chandigarh 160012, India, Tel.: +91 9914208330; +91 172 275 5320; fax: +91 172 2744401, 2745078
    Affiliations
    Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
    Search for articles by this author
  • K.L.N. Rao
    Affiliations
    Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
    Search for articles by this author
Published:September 02, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.08.024

      Summary

      Introduction

      There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002–2020.

      Material and methods

      Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed.

      Results

      There were 27 patients [AUV (n = 11); AUD (n = 16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days–12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n = 3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig. 1B, C). Urethral hypoplasia distal to the valve (n = 4) urethral duplication (n = 1) were associated (Fig. 1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1 mg/dL (n = 5), trabeculated bladder (n = 12), and vesicoureteral reflux (VUR) (n = 12) was noted at presentation. Diverticulum/valve excision (n = 13, 48.2%), fulguration alone (n = 12, 44.4%) and primary urinary diversion (n = 2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n = 6), VUR (n = 4), impaired renal function on scans (n = 8), and lower urinary tract dysfunction (n = 7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1 mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60 ml/kg/min.

      Conclusions

      Summary Fig. 1
      Graphical AbstractMicturating cystourethrogram: (A) PUV with AUD showing trabeculated bladder, right grade V VUR, dilated posterior urethra, non-dilated membranous urethra and dilated bulbar urethra; (B and C) AUV in mid urethra shows large smooth walled bladder, proximal urethral dilatation till bladder neck with abrupt narrowing distally while retrograde urethrography delineates the valve in mid anterior urethra and true calibre of distal urethra; (D) AUD in the dorsal wall of urethral duplication with smooth walled bladder, right grade III VUR.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jehannin B.
        Congenital obstructive valves and diverticula of the anterior urethra.
        Chir Pediatr. 1990; 31: 173-180
        • Cruz-Diaz O.
        • Salomon A.
        • Rosenberg E.
        • Moldes J.M.
        • Badiola de, F
        • Labbie A.S.
        • et al.
        Anterior urethral valves: not such a benign condition.
        Front Pediatr. 2013; 1: 1-6
        • Prakash J.
        • Dalela D.
        • Goel A.
        • Singh V.
        • Kumar M.
        • Garg M.
        • et al.
        Congenital anterior urethral valve with or without diverticulum: a single-centre experience.
        J Pediatr Urol. 2013; 9: 1183-1187
        • Rao K.L.N.
        • Eradi B.
        • Menon P.
        Anterior and Posterior urethral valves: a rare association.
        J Pediatr Surg. 2003; 38: 23-24
        • Kajbafzadeh A.M.
        • Sharifi S.H.H.
        • Keihani S.
        • Soltani M.H.
        • Tajali A.
        • Salavati A.
        • et al.
        Concomitant anterior and posterior urethral valves in pediatrics: a single centre experience over 12 years and long term follow up after endoscopic treatment.
        Int J Urol. 2015; 22: 514-519
        • Gordon I.
        • Piepsz A.
        • Sixt R.
        Guidelines for standard and diuretic renogram in children.
        Eur J Nucl Med Mol Imag. 2011; https://doi.org/10.1007/s00259-011-1811-3
        • Custer J.W.
        • Rau R.E.
        Pediatric parameters and equipment.
        in: Custer J.W. Rau R.E. The Harriet Lane handbook. 18th ed. Elsevier Mosby, Philadelphia2009 (inside title page)
        • Schwartz G.J.
        • Munoz A.
        • Schneider M.F.
        • Mak R.H.
        • Kaskel F.
        • Warady B.A.
        • et al.
        New equations to estimate GFR in children with CKD.
        J Am Soc Nephrol. 2009; 20: 629-637
        • Mian A.N.
        • Schwartz G.J.
        Measurement and estimation of glomerular filtration rate in children.
        Adv Chron Kidney Dis. 2017; 24: 348-356
        • Routh J.C.
        • McGee S.M.
        • Ashley R.A.
        • Reinberg Y.
        • Vandersteen D.R.
        • et al.
        Predicting renal outcomes in children with anterior urethral valves: a systematic review.
        J Urol. 2010; 184: 1615-1619
        • Williams D.I.
        • Retik A.B.
        Congenital valves and diverticula of the anterior urethra.
        Br J Urol. 1969; 41: 228-234
        • Van Savage J.G.
        • Khoury A.E.
        • McLorie G.A.
        • Bagli D.J.
        An algorithm for the management of anterior urethral valves.
        J Urol. 1997; 158: 1030-1032
        • Huang C.J.
        • Bai J.W.
        • Liang R.X.
        • Sun N.
        Congenital anterior urethral valves and diverticula-analysis of 50 cases.
        Ann Acad Med Singapore. 1989; 18: 665-668
        • Kolte S.P.
        • Joharpurkar S.R.
        Anterior urethral valves - a rare cause of urethral obstruction.
        Indian J Pediatr. 2001; 68: 83-85
        • Paulhac P.
        • Fourcade L.
        • Lesaux N.
        • Alain J.L.
        • Colombeau P.
        Anterior urethral valves and diverticula.
        BJU Int. 2003; 92: 506-509
        • Kaplan G.W.
        • Scherz H.C.
        Anterior urethral valves.
        in: Kelalis P.P. King L.R. Belman A.B. Clinical pediatric urology. 3rd ed. Saunders, Philadelphia, PA1992: 851e3
        • Blasl F.
        • Rosch W.H.
        • Koen M.
        • Ardelean M.A.
        Cowper's syringocele: a rare differential diagnosis of infravesical obstruction in boys and young adults.
        J Pediatr Urol. 2017; 13: 52e1-52e5https://doi.org/10.1016/j.jpurol.2016.08.023
        • Sorensen F.E.
        • Skott M.
        • Rawashdeh Y.F.
        • Kirkeby H.J.
        Syringocele: a retrospective study and review of the literature.
        Scand J Urol. 2019; 53: 269-274
        • Firlit R.S.
        • Firlit C.F.
        • King L.P.
        Obstructing anterior urethral valves in children.
        J Urol. 1978; 119: 819-822
        • Rawat J.
        • Khan T.R.
        • Singh S.
        • Maletha M.
        • Kureel S.N.
        Congenital anterior urethral valves and diverticula: diagnosis and management in six cases.
        Afr J Paediatr Surg. 2009; 6: 102-105
        • Yaxley R.P.
        Congenital valves of the anterior urethra.
        Med J Aust. 1969; 2: 295-297
        • Golimbu M.
        • Orca M.
        • Al-Askari S.
        • Morales P.
        • Golimbu C.
        Anterior urethral valves.
        Urology. 1978; 12: 343-346https://doi.org/10.1016/0090-4295(78)90403-X
        • Firlit C.F.
        • King L.P.
        Anterior urethral valves in children.
        J Urol. 1972; 108: 972-975
        • Aygün C.
        • Güven O.
        • Tekin M.I.
        • Peskircioglu L.
        • Ozkardes H
        Anterior urethral valve as a cause of end-stage renal disease.
        Int J Urol. 2001; 8: 141-143
        • Kajbafzadeh A.M.
        • Payabvash S.
        • Karimian G.
        Urodynamic changes in patients with anterior urethral valves: before and after endoscopic valve ablation.
        J Pediatr Urol. 2007; 3: 295-300
        • Priti K.
        • Rao K.L.N.
        • Menon P.
        • Singh N.
        • Mittal B.R.
        • Bhattacharya A.
        • et al.
        Posterior urethral valves: incidence and progress of vesicoureteric reflux after primary fulguration.
        Pediatr Surg Int. 2004; 20: 136-139
        • Menon P.
        • Rao K.L.N.
        • Vijaymahantesh S.
        • Kanojia R.P.
        • Samujh R.
        • Batra Y.K.
        • et al.
        Posterior urethral valves: morphological normalization of posterior urethra after fulguration is a significant factor in prognosis.
        J Indian Assoc Pediatr Surg. 2010; 15: 80-86