Diversion in Posterior Urethral Valves: Needs and Results
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 2
Abstract
Objective: The objective is to evaluate the outcome of diversion procedures done for posterior urethral valves (PUV). Materials and Methods: A retrospective study was done on 29 patients out of 203 patients of PUV treated in the Department of Paediatric surgery at a tertiary care center from January 2011 to December 2016. Data regarding clinical history, examination findings, investigation results, and treatment given were collected from their case records. Data collected were analyzed. Results: A total of 203 patients with a mean age of 31.78 ± 9.11 months presented to the Paediatric Surgery Department with dribbling, poor urinary stream (55.17%), and urinary tract infection (36.94%) as the major symptoms. Vesicoureteric reflux was found in 55.66% cases. While 71.92% patients had cystoscopic fulguration, in 13.79% patients, we had to use Chooramani hook to ablate the valves and 28 (14.29%) patients had to be diverted to treat urosepsis. Valve bladder syndrome occurred in 60.59% cases. Of the 28 diverted patients, 21 had vesicostomy and 8 had ureterostomy. Of the 12 patients with vesicostomy, 7 showed lessening of serum creatinine and lessening of reflux with age; two patients showed high pressure, small capacity bladder. Two patients showed poor voiding and are on chronic kidney disease medications as advised by the nephrologist. One patient had bilateral ureteric reimplant after optimization of bladder function. Rest 12 patients are still on vesicostomy. Of the eight patients with ureterostomy, 2 had ureterostomy closure and are doing well on follow-up; 2 had bilateral ureteric reimplant, of which 1 died and the other is doing well; other 4 are still on ureterostomy. Urodynamic evaluation could be done in only two patients after vesicostomy closure and one after ureterostomy closure. Closed vesicostomy patients showed small capacity, high-pressure bladder, while closed ureterostomy patient showed normal capacity and normal pressure bladder. Other patients are awaiting urodynamic evaluation. Mean follow-up in our series was 2.6 ± 1.1 years.
Authors and Affiliations
Ramdhani Yadav, Sandip Kumar Rahul, Vinit Kumar Thakur
Keywords
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