O. Fituri, A. Nasuf, M.Turki, A. Bouaeshi
Department of Paediatrics, Alfatah University Tripoli-Libya
Tripoli Children Hospital, Tripoli, Libya
JMJ Vol.3 No.2 (September) 2004: 80-81
Posterior urethral valves (PUV) the most common cause of severe obstructive uropathy in infants and children (1/8000). Urethral valve refers to tissues leaflets fanning distally from the prostatic urethra to the external urinary sphincter. The renal changes range from mild hydronephrosis to severe renal dysplasia depends on the severity of obstruction and the time of its onset in the foetal life. (1) The diagnosis is established by voiding cystourethrography. Clinical presentation varies, it is related to the severity of obstruction; antenatal diagnosis by ultrasound (48-50%)(2),at neonatal period as (potter syndrome, palpable bladder, poor urinary stream ,urinary tract infection (UTI),respiratory distress 25-50%)(2) and at older age it presents as failure to thrive ,UTI, hydronephrosis 90%(2).A strong urinary stream does not preclude the diagnosis of posterior valve. The pathophysiological effect (3) of the valve is attributed to the high pressure generated by urethral obstruction transmitted to the upper urinary tract; as a result of obstruction the urethra dilates proximally and elongates, the detrusor muscles hypertrophies in response to extra work involved in voiding with resultant trabeculation & sacculation. This Detrusor hypertrophy also produces relative hypertrophy of the vesical neck (vesicourethral reflux 25-50%)(2) these two mechanisms lead to hydronephrosis, renal parenchymal damage in the form of renal dysplasia or interstial nephritis. Despite advances in diagnosis and in surgical and medical treatment, chronic renal failure develops in many children with PUV (50%) (2). Our aim of this study was to estimate the outcome of PUV in Libyan boys.
Keywords: Posterior urethral valve, obstructive uropathy, cystourethrography