title: Concomitant anterior and posterior urethral valves in pediatrics: A single center experience over 12 years and long-term follow up after endoscopic treatment.
abstract: OBJECTIVE
  To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves.
  
  
  METHODS
  We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded.
  
  
  RESULTS
  From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients.
  
  
  CONCLUSIONS
  Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves.
authors.affiliation: Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Hosseini Sharifi
authors.forename: Sorena
authors.initials: S
authors.lastname: Keihani
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Soltani
authors.forename: Afshin
authors.initials: A
authors.lastname: Tajali
authors.forename: Alborz
authors.initials: A
authors.lastname: Salavati
authors.forename: Seyedmehdi
authors.initials: S
authors.lastname: Payabvash
authors.forename: Mehrzad
authors.initials: M
authors.lastname: Mehdizadeh
mesh_terms: D000368:Aged; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D001745:Urinary Bladder Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D014552:Urinary Tract Infections; D014563:Urodynamics
chemical_list: D019783:Technetium Tc 99m Dimercaptosuccinic Acid
keywords: anterior urethral diverticulum; anterior urethral valve; bladder outlet obstruction; posterior urethral valve; urodynamics