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
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
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Article info
Publication history
Published online: September 02, 2022
Accepted:
August 27,
2022
Received in revised form:
August 21,
2022
Received:
March 20,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
