Fall I, Ba M, Gueye S M, Ndoye M, Diagne B A, Mensah A, Diop A
Unité de Chirurgie Infantile, Hôpital A. Le Dantec, Dakar, Sénégal.
Ann Pediatr (Paris). 1992 Jun;39(6):375-80.
Fourteen pediatric cases of posterior urethral valves in patients aged 6 months to 14 years (with four infants and ten older children) are reported. The main symptoms were vesical, including dysuria, acute urinary retention and dribbling. One patient presented with diarrhea, vomiting and dribbling. Urethral valves were looked for as part of the evaluation for urinary lithiasis in one patient, and in another urinary lithiasis developed following the diagnosis of urethral valves. In half the cases, onset of symptoms occurred within one year of birth. Urethrocystography allowed to evidence the valves and to evaluate repercussions on the bladder including hyperplasia (7 cases) and diverticula (2 cases). The intravenous urogram disclosed bilateral ureterohydronephrosis in eight cases. Pathogens recovered from the urine included Klebsiella (3 patients), Pseudomonas (4 patients), Proteus (one patient), and E. coli (one patient). Most patients were treated by catheter lamination under antimicrobial therapy. Two patients died from renal failure. Results were considered satisfactory in nine cases with follow-ups ranging from 1 month to 4 years. Three patients were lost to follow-up. Early diagnosis is essential and management should rely mainly on endoscopic resection which reduces the length of the hospital stay and the risk of infection.
报告了14例年龄在6个月至14岁的小儿后尿道瓣膜病例(其中4例为婴儿,10例为大龄儿童)。主要症状为膀胱相关症状,包括排尿困难、急性尿潴留和滴尿。1例患者出现腹泻、呕吐和滴尿。1例患者因尿路结石评估而检查尿道瓣膜,另1例在诊断尿道瓣膜后发生尿路结石。半数病例症状在出生后1年内出现。尿道膀胱造影可显示瓣膜并评估对膀胱的影响,包括增生(7例)和憩室(2例)。静脉肾盂造影显示8例双侧输尿管肾盂积水。从尿液中分离出的病原体包括克雷伯菌(3例患者)、铜绿假单胞菌(4例患者)、变形杆菌(1例患者)和大肠杆菌(1例患者)。大多数患者在抗菌治疗下接受导尿管置入术治疗。2例患者死于肾衰竭。9例随访时间为1个月至4年的患者结果令人满意。3例患者失访。早期诊断至关重要,治疗应主要依靠内镜切除,这可缩短住院时间并降低感染风险。