Posterior urethral valves: epidemiological, diagnostic and therapeutic aspects in yaoundé gynaeco-obstetric and paediatric hospital, a 10 year review of cases.
MOUAFO TAmbo Faustin F. ; Paul Nkemtendong TOLEFAC ; NGOWE Ngowe Marcelin ; MBOUCHE Landry ; GUEKAM Georgette ; TELELEN Alemnju Neville
CaHReF 2016, Yaoundé Conges hall, 23 – 26 August 2016 , PL012
The incidence of Posterior urethral valve (PUV) is estimated at 1:5000 – 1:8000 males. PUV is the most common paediatric urologic emergency and the most common cause of male obstructive uropathy and chronic renal failure in children.
Retrospectively medical records were retrieved over a ten year period (March 2005-April 2016) and all data recorded and analysed for study objectives. Patients were called and evaluated in a prospective phase for outcome in terms of morbidity and mortality.
A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 PUV per annum. The mean age at presentation was 32.61months. In 72.20% of the cases the diagnosis was made after 1 month of age. The most common urinary symptom on admission were dribbling (61.1%) , most common non urinary symptom was fever (38.9%), most common finding on physical examination was palpable bladder (50.0%) and most common complication on admission was recurrent urinary tract infection(61.10%). The mean creatinine and GFR on admission were respectively 16.56±16.01mg/L and 51.0±43.84ml/min/1.73m2. Abdominal ultrasound on admission showed dilated and elongated posterior urethral valves in 38.9% of cases. Voiding urethrocystogram was done in all the patients and it showed dilated and elongated posterior urethral valves in 88.9% of the cases. All the patients had a urethrocystoscopy done which resulted in improvement of symptoms in all but 16.7% of patients that had residual valves and 11.1% of patients that had urethral stenosis from the procedure. Intra-operatively type I valves were most common constituting 78.0% of the valves . The mean duration of follow up was 34.56±21.47months. complications at final follow up (prospective) were: mortality rate of 5.56%, 55.60% developed chronic renal failure, 11.1% end stage renal failure, 28.0% UTI, 50.0% anaemia, 29.0% hypertension and 33.35% failure to thrive. No statistical significance difference between complications present before and at final follow up with p value = 0.05 using the McNemar test.
Many patients present late in our setting with PUV with already established complications. There is the need to counsel parents
Posterior urethral valve, epidemiologic, diagnostic, therapeutic, Children, Yaounde, Outcome