title: An algorithm for the management of anterior urethral valves.
abstract: OBJECTIVE
  We present our management algorithm for patients with anterior urethral valves seen in the last 2 decades with and without the benefit of prenatal sonography.
  
  
  METHODS
  A case series design was used to study 17 cases of anterior urethral valves. Five patients presented with prenatal hydronephrosis from 1984 to 1993 and 12 presented with predominant voiding symptoms between 1975 and 1996 at a mean age of 6 years.
  
  
  RESULTS
  Treatment included supravesical diversion in 1 case, vesicostomy in 5, urethroplasty in 5 and transurethral fulguration in 6. Four of the 5 patients with a prenatal diagnosis of hydronephrosis had moderate to severe hydronephrosis compared to 3 of the 12 who did not undergo prenatal sonography. All 17 patients were continent and infection-free, and had little or no hydronephrosis at a mean followup of 5 years.
  
  
  CONCLUSIONS
  We recommend vesicostomy in infants with high grade bilateral vesicoureteral reflux and poor emptying of the urinary tract, transurethral fulguration if the urethra has sufficient caliber and support, and urethroplasty in other patients. Based on our management algorithm patients with anterior urethral valves do not have sequelae due to distal obstruction of the urinary tract.
authors.affiliation: Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: J G
authors.initials: JG
authors.lastname: Van Savage
authors.forename: A E
authors.initials: AE
authors.lastname: Khoury
authors.forename: G A
authors.initials: GA
authors.lastname: McLorie
authors.forename: D J
authors.initials: DJ
authors.lastname: Bägli
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000628:therapy; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D014521:Urethra / Q000002:abnormalities*; D014524:Urethral Obstruction / Q000209:etiology / Q000628:therapy*