Residual valve and stricture after posterior urethral valve ablation: How to evaluate?

• Published in: Journal of pediatric urology Vol. 9; no. 2; pp. 184 - 187
• Main Authors: Oktar, Tayfun, Salabas, Emre, Acar, Omer, Atar, Arda, Nane, Ismet, Ander, Haluk, Ziylan, Orhan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2013
• Subjects: Child; Child, Preschool; Female; Follow-Up Studies; Humans; Hydronephrosis - etiology; Hydronephrosis - pathology; Hydronephrosis - surgery; Infant; Male; Pediatrics; Posterior urethral valve; Postoperative Complications - etiology; Postoperative Complications - pathology; Postoperative Complications - surgery; Predictive Value of Tests; Reoperation; Residual valve; Retrospective Studies; Treatment Outcome; Ureteroscopy; Urethral stricture; Urethral Stricture - pathology; Urethral Stricture - surgery; Urologic Surgical Procedures - adverse effects; Urology; Vesico-Ureteral Reflux - etiology; Vesico-Ureteral Reflux - pathology; Vesico-Ureteral Reflux - surgery; Urethral stricture; Posterior urethral valve; Residual valve
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2012.01.016

Abstract Objective To investigate the clinical and radiological parameters of posterior urethral valve (PUV) patients with residual valve or strictures after primary valve ablation. Patients and methods A total of 127 PUV patients were treated in our clinic between 1986 and 2009. We retrospectively reviewed the records of 101 patients, who had at least 1 year of follow-up data, regarding the presence of valve remnants or urethral strictures after PUV ablation. Results A total of 21 patients (20.8%) underwent repeat-urethroscopy and, of these, residual valve leaflets or stricture were detected in 10 patients (10/101, 9.9%). In 2 of these 10 (20%), the urethra had been found to be normal on the first voiding cystourethrogram following ablation. However, these two boys underwent re-urethroscopy due to persistent vesicoureteral reflux in one and persistent hydroureteronephrosis in the other, and valve remnants were detected. The remaining 8 cases had radiological signs consistent with persistent infravesical obstruction in the early period. Obstruction was due to urethral stricture and residual valve remnants in 2 and 6 cases, respectively. Conclusions There was clinical suspicion of residual valve in about 20% of the cases and in half of these the urethra was found to be normal on urethroscopy. The possible presence of residual valve remnants after primary valve ablation should be confirmed by careful clinical, radiological and endoscopic evaluation.