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Current Trends In Medical And Clinical Case Reports

Presentation and early Surgical outcome in the late presenting posterior urethral valve at Kilimanjaro Christian Medical Centre-Tanzania

Frank Chacha, J.S. Mbwambo, Frank Bright, K.A. Mteta

 

Kilimanjaro Christian Medical University College, Tanzania

 

*Corresponding Author: Frank Chacha, Kilimanjaro Christian Medical University College, Tanzania, E-mail Id: [email protected]

 

Citation: Frank Chacha (2020) Late Diagnosis and Poor Treatment of Posterior Urethra Valve From Kilimanjaro Christian Medical Cente, Tanzania. Current Trends Med Clin Case Rep, 1(1); 1-7

 

Copyright: © 2020, Chacha F, This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

 

ABSTRACT

 

Background: Posterior urethra valve is one of the few urological condition that require early diagnosis during antennal life and early antenatal intervention. Miss diagnosis or delay in treatment would leads to progressive renal deterioration and finally end stage hydronephrosis. The objective of the study is to determine presentation and early surgical outcome of late presenting PUV among children seen at KCMC from January 2008 to October 2015.

Methodology: This was a descriptive cross-sectional hospital based study. It involved patients presented in the Institute of Urology at KCMC confirmed to have PUV, and operated during the period of study from January 2008 to October 2015.

Results: A total number of 104 cases were diagnosed and treated for PUV. Of 57 (78%) cases of study participants had pre-operation Serum creatinine tested, and was found to be high in 11 (19.3%) of the patients. 18 (24.7%) were found to have vesical ureteric reflux, more common grade were grade 7 and 5, in about 7 (38.9%) and 5 (27.8%) respectively. Initial treatment was given included vesicostomy 29 (39.7) and catheterization 5 (6.9%), 56 (76.7%) underwent definitive surgical treatment (valve ablation) in which 38 (67.9) had electrofulgration and 18 (32.1%) had cold knife. Typical type I PUV were observed in 55 (98.2%), and only 1 patient had had type III. 28 (67.7%) of 56 patients after valve ablation in 6 months follow up period had good voiding urine stream. Surgical complications noted were urethral stricture 1(2.4%) patient, residual valve 3 (7.5%) patients and urinary incontinence in 2 (4.9%) patients, in which all were from the age group of 12 to 60 months. Post vesicostomy was initial treatment, 3 (10.3%) had vesicostomy stenosis, 1 (3.4%) bladder prolapse and 2 (6.9%) died. Cold knife have lesser complications when compared to electrofulgration in which 2 (7.4%) had residual valve, 2 (7.4%) had urethral stricture and one (3.7%) developed urine incontinence after electrofulgration.

Conclusion: A significant number of PUV patients whom are seeing at KCMC present late with complications of the disease. Most prevalent age group was 13 to 60 months this may be attributed by a delay in referrals.

 

KEYWORD: Pediatric Urology, Posterior Urethra Valve, Surgical Outcome

 

BIBLIOGRAPHY

 

1. Akdogan B, et al. Significance of age-specific creatinine levels at presentation in posterior urethral valve patients. Journal of Pediatric Urology. 2006;2(5):446-452.

2. Ansari MS, et al. "Delayed presentation in posterior urethral valve: Long-term implications and outcome. Urology. 2008;71(2):230-234.

3. Bomalaski MD, et al. delayed presentation of posterior urethral valves: a not so benign condition. The Journal of Urology 1999;162(6):2130-2132.

4. Casella DP, Tomaszewski JJ, Ost MC. Posterior urethral valves: Renal failure and prenatal treatment. International Journal of Nephrology. 2012:3-7.

5. Darge K. Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children: I. Procedure. Pediatric Radiology. 2008;38(1):40-53.

6. Dewan PA. Congenital obstructing posterior urethral membrane (COPUM): further evidence for common morphological diagnosis. Pediatr Surg Int. 1993;8:45-50.

7. De Gennaro M, et al. The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves. BJU Int. 2000;85:1104-1108.

8. Godwin OI, Ayotunde OO. Posterior Urethral Valves with Severe Unilateral Vesicoureteral Reflux in a 3-year-old Boy. Annals of Ibadan Postgraduate Medicine. 2007;5(2):73-76.

9. Hendren WH. Posterior urethral valves in boys. A broad clinical spectrum. J Urol. 1971;106:298-307.

10. Ikuerowo SO, et al. Clinical and radiological characteristics of Nigerian boys with posterior urethral valves. Pediatric Surgery International. 2008;24(7):825-829.

11. Kibar Y, et al. Timing of posterior urethral valve diagnosis and its impact on clinical outcome. Journal of Pediatric Urology. 2011;7(5)l:538-542.

12. Krishnan A, de Souza A, Konijeti R, Baskin LS. The anatomy and embryology of posterior urethral valves. J Urol. 2006;175:1214-1220.

13. Mteta KA Kaali, SN Musau, P.& M.M. Management of PUV at KCMC. East Cent. Afr J Surg. 2012;17(1):112-120.

14. Odetunde OI, et al. Outcome of late presentation of posterior urethral valves in a resource-limited economy: challenges in management. International Journal of Nephrology. 2012;345298.

15. Okafor HU, Ekenze SO, Uwaezuoke SN. Posterior urethral valves: Determinants of outcome in a developing country. Journal of Paediatrics and Child Health. 2013;49(2):115-119.

16. Oktar T, et al. Residual valve and stricture after posterior urethral valve ablation: How to evaluate? Journal of Pediatric Urology. 2013;9(2):184-187.

17. Orumuah AJ, Oduagbon OE. Presentation, management, and outcome of posterior urethral valves in a Nigerian tertiary hospital. African Journal of Paediatric Surgery. 2015;12(1):18-22.

18. Schober JM, Dulabon LM, Woodhouse CR, Outcome of valve ablation in late-presenting posterior urethral valves. BJU International. 2004;94(4):616-619.

19. Uthup S, et al. A follow-up study of children with posterior urethral valve. Indian Journal of Nephrology. 2010;20(2):72-75.

20. Ziylan O, et al. The impact of late presentation of posterior urethral valves on bladder and renal function. The Journal of Urology. 2006;175(5);1894-1897.

21. AZornoza M, et al. Late diagnosis of posterior urethral valves. Actas Urologicas Espanolas. 2015;1699-7980.

 

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