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2.1
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]

Two other patients presented postnatally at 1 and 2 years of age, respectively, with poor stream of urine since birth. The fourth patient presented at 9 years with frequency and dysuria. [ingentaconnect.com]

Time of presentation depending on the severity of the anatomical obstruction, it may present antenatally, soon after birth or later in childhood. The clinical presentation of anterior urethral valves is similar to that of PUV. [medresearch.in]

Entire Body System

  • Enuresis

    His nocturnal enuresis had completely subsided at a follow-up period of longer than 24 months. [ncbi.nlm.nih.gov]

    日向 泰樹, 中井 秀郎, 川合 志奈, 中村 繁 夜尿症研究 = Enuresis : 日本夜尿症学会雑誌 19 49-54 May 2014 Pediatric daytime incontinence/non-monosymptomatic nocturnal enuresis requiring referral to pediatric urologists from pediatricians 渡邊 常樹, 藤永 周一郎, 池田 裕一, 日向 泰樹, 川合 志奈, 中村 繁, 中井 [researchmap.jp]

    […] bladder disorders 739 Chapter 51 Urodynamics of the lower and upper urinary tract 747 Chapter 52 Neurologic control of storage and voiding 765 Chapter 53 Neurogenic voiding dysfunction and nonsurgical management 781 Chapter 54 Diurnal and nocturnal enuresis [books.google.com]

    Older children may complain of milder symptoms like frequency, dysuria, hematuria, enuresis, diminished urinary stream and post-void dribbling, as in our patient [4]. [ispub.com]

Urogenital

  • Incontinence

    Focus on today's hot topics in urology, including stress and mixed urinary incontinence; prolapse therapy; therapy for overactive bladder; and targeted therapy for renal cell carcinoma. [books.google.com]

    None of the patients contacted had day/night incontinence or stress incontinence. None reported any urinary symptoms except one complaining of incomplete voiding sensation (post-void residue 6cc in last ultrasonography). [spuonline.org]

    Symptoms and signs of epispadias are incontinence, reflux, and UTIs. Treatment of epispadias is surgical. In partial epispadias, prognosis for continence with treatment is good. [merckmanuals.com]

    Last updated: Jan 30, 2018 at 21:48 Name Hideo Nakai Nickname H.Nakai E-mail hnakai jichi.ac.jp Affiliation Jichi Medical University Research funding number 50167540 Research Interests cryptorchidism(1), nocturnal enuresis(2), urinary incontinence(3), [researchmap.jp]

Workup

Colonoscopy

  • Polyps

    An oblique VCUG image shows a dilated posterior urethra (arrow) and a trabeculated urinary bladder Click here to view Posterior urethral polyp Posterior urethral polyp, a rare cause of intermittent urethral obstruction, [16] is an elongated pedunculated [ijri.org]

    DISCUSSION Anterior urethral valves (AUV) are a rare cause of urinary obstruction in male children. 1 Other common causes include posterior urethral valves, ureterocele, bladder diverticulae, meatal stenosis, urethral polyps and bladder stones. [pjms.com.pk]

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]

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. [banglajol.info]

Treatment [ edit ] If suspected antenatally, a consultation with a paediatric surgeon/ paediatric urologist maybe indicated to evaluate the risk and consider treatment options. Treatment is by endoscopic valve ablation. [en.wikipedia.org]

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]

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]

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]

In partial epispadias, prognosis for continence with treatment is good. [merckmanuals.com]

Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis. J Indian Assoc Pediatr Surg. 2010;15(3):80-6. doi:10.4103/0971-9261.71744. 15. [tci-thaijo.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]

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]

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. [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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