Anterior urethral valves in children: an uncommon multipathogenic cause of obstructive uropathy.
BACKGROUND
Anterior urethral valves (AUVs) are uncommon congenital anomalies causing urethral obstruction in boys.


METHODS
Medical records of 13 children were reviewed retrospectively. Each patient (pt) was evaluated with voiding cysto-urethrogram (VCUG) and renal ultrasonography. Pts older than 5 years performed an uroflowmetry. Serum creatine was determined in all children.


RESULTS
All pts had difficulty in voiding and eight had recurrent urinary tract infection. Renal function was normal in all pts. VCUG showed filling of Cowper's duct in a pt. In a case, a vesicoureteral reflux was discovered. Uroflowmetry showed a flat trace in all cases. Transurethral endoscopic resection of the valves was carried out in 11 children while open resection was necessary in two children. At serial follow-up, all pts remain symptom-free and uroflowmetry documented regular pattern.


CONCLUSIONS
Anterior urethral valves are rare lesions that may create problems at different stages. Some AUVs may result from the obstruction distal lip of a ruptured syringocele. Improvements in endoscopic equipment allow for minimally invasive transurethral resection. Large diverticula are best managed with open diverticulectomy and reconstruction. In newborns with severe altered urinary tract drainage, particularly in low birth-weight infant, a vesicostomy may be necessary.
Arena
Salvatore
S
Unit of Pediatric Surgery, Department of Pediatric Surgery, University of Catania, Catania, Italy. arenaf@unime.it
Romeo
Carmelo
C
Borruto
Francesca Astra
FA
Racchiusa
Sergio
S
Di Benedetto
Vincenzo
V
Arena
Francesco
F
D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D003560:Cysts / Q000150:complications / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014524:Urethral Obstruction / Q000150:complications / Q000209:etiology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000601:surgery
D003404:Creatinine