Chertin Boris, Cozzi Denis, Puri Prem
Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
J Urol. 2002 Oct;168(4 Pt 2):1841-3; discussion 1843. doi: 10.1097/01.ju.0000027507.32385.52.
Posterior urethral valves are the most common cause of bladder outlet obstruction in infancy and cause renal failure in 25% to 30% of these children before adolescence. Transurethral ablation under direct vision is the most commonly used method of treatment for posterior urethral valves. Since 1987 we have used a Fogarty balloon catheter for primary avulsion of the posterior urethral valves in our patients. We evaluate the long-term results of this technique.
During 14 years (1987 to 2001) 35 consecutive patients with posterior urethral valves underwent primary valve avulsion using a Fogarty balloon catheter. In 21 patients diagnosis was made prenatally, while the remaining 14 patients (6 newborns and 8 children with median age of 6 months) presented with urinary tract infection and renal failure. Vesicoureteral reflux was present in 22 (63%) of the 35 patients involving 34 renal units. Primary valve avulsion was performed using a 4Fr Fogarty balloon catheter under fluoroscopic control in all patients. Postoperative voiding cystourethrography was done 2 weeks after valve avulsion.
None of the patients demonstrated any evidence of periurethral extravasation during the procedure. Postoperative voiding cystourethrography showed effective relief of valvular obstruction and good urethral drainage in 34 patients. In the remaining patient residual valve required transurethral ablation under direct vision. Vesicoureteral reflux resolved spontaneously in 12 of the 22 (54%) patients (20 renal units) and after an antireflux procedure in 4 (7 units). Two patients (3 renal units) are on antibiotic prophylaxis and 4 underwent nephroureterectomy for nonfunctioning dysplastic kidneys. At followup (1 to 14 years) all patients demonstrated a good urinary stream with no evidence of urethral stricture. Renal function did not improve in 5 (14%) of the 35 patients, 1 of whom has already undergone renal transplantation and another is awaiting transplantation.
Fogarty balloon catheter technique is a simple, safe and effective alternative to primary endoscopic transurethral ablation of posterior urethral valves.
后尿道瓣膜是婴儿期膀胱出口梗阻最常见的原因，并且在青春期前25%至30%的这类儿童中会导致肾衰竭。直视下经尿道切除术是治疗后尿道瓣膜最常用的方法。自1987年以来，我们在患者中使用Fogarty球囊导管对后尿道瓣膜进行初次撕脱术。我们评估该技术的长期效果。
在14年期间（1987年至2001年），35例连续的后尿道瓣膜患者使用Fogarty球囊导管进行了初次瓣膜撕脱术。21例患者在产前确诊，其余14例患者（6例新生儿和8例中位年龄为6个月的儿童）表现为尿路感染和肾衰竭。35例患者中有22例（63%）存在膀胱输尿管反流，累及34个肾单位。所有患者均在透视控制下使用4Fr Fogarty球囊导管进行初次瓣膜撕脱术。瓣膜撕脱术后2周进行术后排尿性膀胱尿道造影。
术中无患者出现任何尿道周围外渗的证据。术后排尿性膀胱尿道造影显示34例患者瓣膜梗阻得到有效缓解，尿道引流良好。其余1例患者残留瓣膜需要直视下经尿道切除。22例患者中有12例（54%）（20个肾单位）的膀胱输尿管反流自发缓解，4例（7个肾单位）在抗反流手术后缓解。2例患者（3个肾单位）接受抗生素预防，4例因发育不良无功能肾接受了肾输尿管切除术。随访（1至14年）时，所有患者尿流良好，无尿道狭窄证据。35例患者中有5例（14%）肾功能未改善，其中1例已接受肾移植，另1例正在等待移植。
Fogarty球囊导管技术是后尿道瓣膜初次内镜下经尿道切除术的一种简单、安全且有效的替代方法。
