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Anterior Urethral Valve

Duplication of Urethra


Presentation

  • Hydro-ureteronephrosis was present in three boys (42%) and reflux was present in one patient. Post-void residual volume was 20 ml (mean 55 ml) in all children.[ncbi.nlm.nih.gov]
  • We present our experience with 2 children with concomitant AUV and PUV as well as a literature review. The clinical presentation of concomitant AUV and PUV is variable.[ncbi.nlm.nih.gov]
  • We present a case of AUV with a diverticulum which was misdiagnosed at other center as neurogenic bladder resulting in chronic renal failure.[ncbi.nlm.nih.gov]
  • We present a neonate with an obstructing anterior urethral valve depicted by longitudinal transpenile ultrasound. Voiding images are recommended to identify the obstructing valve tissue.[ncbi.nlm.nih.gov]
  • We present a case of a 10-month old male child diagnosed with an anterior urethral valve by micturating cystourethrogram.[ncbi.nlm.nih.gov]
Recurrent Infection
  • Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.[ncbi.nlm.nih.gov]
  • The patient may present with poor urinary stream, recurrent infections, or with renal failure. Depending on the severity of anatomical obstruction he may present early at birth or later in childhood if obstruction is minimal [1].[jpgmonline.com]
  • Conclusion Children with poor stream and recurrent infections should be evaluated carefully for congenital obstructive malformation and anterior urethral valves should be considered in differential diagnosis of obstructive lesions.[medresearch.in]
  • The male child may present with poor urinary stream, recurrent infections, or renal failure.[afrjpaedsurg.org]
Left Flank Pain
  • A 14-year-old boy presented with repeated episodes of left flank pain along with fever and chills. Physical examination did not reveal any positive findings. Routine urine examination showed a large number of pus cells.[jpgmonline.com]
  • He occasionally had fever and left flank pain but no lower urinary tract symptoms or recurrent urinary tract infections. His urine was turbid and foul smelling.[afrjpaedsurg.org]
Failure to Thrive
  • Case 2 A 6-month-old male with 1 month history of fever and failure to thrive was found to have acute renal failure. His parents reported a dribbling urinary stream. A catheter was placed, and he was started on intravenous antibiotics for a UTI.[nature.com]
Nocturnal Enuresis
  • His nocturnal enuresis had completely subsided at a follow-up period of longer than 24 months.[ncbi.nlm.nih.gov]
  • enuresis 819 Chapter 55 Operations for the weak bladder outlet 841 current and future techniques 871 Chapter 57 Urinary diversion 911 Chapter 58 The Malone antegrade continence enema MACE 947 Chapter 59 Minimally invasive approaches to lower urinary[books.google.com]
Urethral Disease
  • Imaging of urethral disease: a pictorial review. Radiographics 2004;24 Suppl 1:S195-216 PubMed CrossRef Google Scholar Kim B, Kawashima A, LeRoy AJ. Imaging of the male urethra.[link.springer.com]

Workup

Pyuria
  • Keywords: Adolescent, Case Report, Diverticulum, etiology,surgery,ultrasonography,Human, Male, Pyuria, diagnosis,etiology,Treatment Outcome, Urethra, abnormalities,surgery,ultrasonography,Urethral Obstruction, etiology,surgery,ultrasonography,Urodynamics[jpgmonline.com]
  • Urine microcopy confirmed pyuria and culture grew proteus; 24-hour urinary creatinine clearance was 9.77 ml/min.[afrjpaedsurg.org]
Bladder Trabeculation
  • In Type III, mild bladder trabeculation and ureteral ectasia with low-grade VUR are seen in addition to those findings in Type II.[nature.com]
  • trabeculation / diverticula Treatment and prognosis Antenatal treatment is possible, consisting of vesicoamniotic shunting (allowing urine to exit the bladder via the shunt, bypassing the obstructed urethra).[radiopaedia.org]
  • Female homolog [ edit ] Vector diagram of posterior urethral obstruction causing severe bilateral hydronephrosis and bladder trabeculation The female homolog to the male verumontanum from which the valves originate is the hymen.[en.wikipedia.org]

Treatment

  • Diagnosis may be overlooked and ideal treatment is not standardized when both the valve and diverticulum are simultaneously present. We present our experience of congenital AUV.[ncbi.nlm.nih.gov]
  • As an initial treatment, vesicostomy was performed in the patient. Later, the valve was fulgurated using an endoscopic procedure. During the follow-up period the patient presented normal renal function.[banglajol.info]
  • The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula.[ncbi.nlm.nih.gov]
  • The treatment of choice for an isolated AUV is endoscopic valve ablation. 8 In the presence of a small diverticulum with adequate spongiosum, transurethral resection is the favored treatment method.[nature.com]
  • Renal and bladder function can be preserved by early diagnosis and treatment. Therefore, we reviewed the symptoms at the time of diagnosis in reported Japanese cases.[jstage.jst.go.jp]

Prognosis

  • The long-term prognosis is good. No References No Citations No Supplementary Data No Article Media No Metrics[ingentaconnect.com]
  • The long-term prognosis of AUVs is not clear in the literature.[medresearch.in]
  • Number of Figures: 2 Number of Tables: 2 ISSN: 1015-3837 (Print) eISSN: 1421-9964 (Online) For additional information: Abstract Anterior urethral valves are a rare congenital anomaly associated with distal urethral obstruction, which can result in a poor prognosis[karger.com]
  • In partial epispadias, prognosis for continence with treatment is good.[merckmanuals.com]
  • The overall prognosis is most affected by the degree and duration of obstruction. Severe cases with obstructive cystic renal dysplasia, oligohydramnios and pulmonary hypoplasia are often incompatible with life 2.[radiopaedia.org]

Etiology

  • Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction.[ncbi.nlm.nih.gov]
  • The etiology is reviewed and strategies recommended for patients with these rare entities. Copyright 2010. Published by Elsevier Ltd.[ncbi.nlm.nih.gov]
  • Keywords: Adolescent, Case Report, Diverticulum, etiology,surgery,ultrasonography,Human, Male, Pyuria, diagnosis,etiology,Treatment Outcome, Urethra, abnormalities,surgery,ultrasonography,Urethral Obstruction, etiology,surgery,ultrasonography,Urodynamics[jpgmonline.com]
  • Various proposed etiologic mechanisms include an abortive attempt at urethral duplication, failure of alignment between the proximal and distal urethra, imbalanced tissue growth in the developing urethra resulting in a remnant of excess tissue acting[mirc.luriechildrens.org]
  • Chapter 41 Laparoscopic management of duplication anomalies 649 anatomic and functional basis of etiology 655 Chapter 43 Nonsurgical management of vesicoureteral reflux 663 Chapter 44 Surgery for vesicoureteral reflux 673 Chapter 45 Minimally invasive[books.google.com]

Epidemiology

  • Epidemiology Most common cause of lower urinary tract obstruction in males The incidence is estimated to be between 1:3,000 and 1:8,000 live male births.[unboundmedicine.com]
  • Epidemiology In the United States, PUV is the most common cause of lower urinary tract obstruction in male neonates; the reported incidence ranges from 1 per 8000 to 1 per 25,000 live births.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Commonly associated pathophysiologic findings in children with PUV include (1) hydroureteronephrosis, (2) dilated bladder with trabeculations and/or diverticulum, and (3) vesicoureteral reflux.[unboundmedicine.com]
  • Pathophysiology During the early stages of embryogenesis, the most caudal end of the wolffian duct is absorbed into the primitive cloaca at the site of the future verumontanum in the posterior urethra.[emedicine.medscape.com]

Prevention

  • Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra. DOI: Community Based Medical Journal 2013 July: Vol.02 No 02: 71-74[banglajol.info]
  • Early diagnosis and management of this rare condition is very important to prevent further damage, infection and vesicoureteral reflux.[ruj.uj.edu.pl]
  • Surgery (usually via endoscopy) is done at time of diagnosis to prevent progressive renal deterioration.[merckmanuals.com]
  • Your child will be given antibiotics to prevent infection occurring following the catheterisation.[kidney.org.uk]
  • Early diagnosis can prevent renal damage in many patients. REFERENCES 1. Naradimhan KL, Choudhary SK, Kaur B. Anterior urethral valves. Indian Pediatrics 2005;42:708-10. 2. Kolte SP, Joharpurkar SR.[pjms.com.pk]

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