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

  • P. Menon
    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
    Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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  • K.L.N. Rao
    Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Published:September 02, 2022DOI:



      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.


      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.


      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.


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