Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2010  |  Volume : 15  |  Issue : 3  |  Page : 80--86

Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis


Prema Menon1, K. L. N. Rao1, S Vijaymahantesh1, RP Kanojia1, R Samujh1, YK Batra2, KS Sodhi3, AK Saxena3, A Bhattacharya4, BR Mittal4 
1 Department of Pediatric Surgery, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Anesthesiology, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Radio-Diagnosis Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Nuclear Medicine, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Prema Menon
Department of Pediatric Surgery, A.P.C., P.G.I., Chandigarh - 160 012
India

Aim: To assess the changes in urethral morphology 3 months post fulguration of posterior urethral valves (PUVs) on micturating cystourethrogram (MCUG) and correlate these changes with the overall clinical status of the patient. Materials and Methods: A total of 217 children, managed for PUVs during a period of 6 years in a single surgical unit were prospectively studied. The ratio of the diameters of the prostatic and bulbar urethras (PU/BU) was calculated on the pre- and post-fulguration MCUG films. They were categorized into three groups based on the degree of normalization of posterior urethra (post-fulguration PU/BU ratio). Results: Group A: Of the 133 patients, 131 had normal urinary stream and 4 (3%) had nocturnal enuresis. Vesicoureteral reflux (VUR), initially seen in 83 units (31% units), regressed completely at a mean duration of 6 months in 41 units (49%). Of the 152 non-VUR, hydroureteronephrosis (HUN) units, 11 were poorly functioning kidneys. Persistent slow but unobstructed drainage was seen in 23 units (16%) over a period of 1.5-5 years (mean 2.5 years). Group B: All the 11 patients had a normal stream. Four (36.4%) had daytime frequency for a mean duration of 1 year and one (9%) had nocturnal enuresis for 1 year. Grade IV-V VUR was seen in five patients (three bilateral), which regressed completely by 3 months in five units (62.5%). In the non-VUR, HUN patients, slow (but unobstructed) drainage was persistent in two units (14%) at 3 years. Group C: Of the 16 patients, only 5 (31.3%) were asymptomatic. Six patients (nine units) had persistent VUR for 6 months to 3 years. Of the 20 units with HUN, 17 (85%) were persistent at 1-4 years (mean 2 years). Eight patients (50%) required a second fulguration while 3 (18.7%) required urethral dilatation for stricture following which all parameters improved. Conclusions: Adequacy of fulguration should be assessed by a properly performed MCUG. A postop PU/BU ratio >3 SD (1.92) should alert to an incomplete fulguration or stricture. Patients within normal range ratio have faster recovery of slow draining units, reflux and less voiding dysfunction. There is a strong correlation between incomplete fulguration and persistent slow draining units, uremia, voiding dysfunction and urinary tract infections.


How to cite this article:
Menon P, Rao K, Vijaymahantesh S, Kanojia R P, Samujh R, Batra Y K, Sodhi K S, Saxena A K, Bhattacharya A, Mittal B R. Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis.J Indian Assoc Pediatr Surg 2010;15:80-86


How to cite this URL:
Menon P, Rao K, Vijaymahantesh S, Kanojia R P, Samujh R, Batra Y K, Sodhi K S, Saxena A K, Bhattacharya A, Mittal B R. Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis. J Indian Assoc Pediatr Surg [serial online] 2010 [cited 2019 Dec 6 ];15:80-86
Available from: http://www.jiaps.com/article.asp?issn=0971-9261;year=2010;volume=15;issue=3;spage=80;epage=86;aulast=Menon;type=0