Gupta S D, Khatun A A, Islam A I, Shameem I A
Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh.
Mymensingh Med J. 2009 Jul;18(2):239-44.
Posterior urethral valves are the most common cause of congenital obstructive uropathy leading to renal failure in childhood. This study was undertaken to assess the outcome of endoscopic fulguration of posterior urethral valves based upon the clinical, radiological and laboratory findings. This prospective study was carried out on 50 male children with posterior urethral valves who were treated by endoscopic fulguration and came for routine follow-up. Diagnosis of posterior urethral valves (PUV) was confirmed by voiding cystourethrogram (VCUG). After valve ablation, urine R/M/E, urine for culture and sensitivity test, serum creatinine level, USG of KUB including PVR were done in all cases at 1,3,6,12 months and then at six months interval maximum up to 3 years. Mean age of the patients was 2 years ranging from 1 to 12 years old. Mean follow-up period was 30.48 months after valve ablation. At diagnosis mean serum creatinine +/-SD was 90.4+/-44.8 mumol/lit and it decreased to 56.3+/-11.1micromol/lit at the end of 3-years follow-up. Hydronephrotic changes decreased from 84% to 4%. Proteinuria decreased from 38% to 6% and urinary tract infections decreased from 58% to 4% at the end of final follow up. Although the techniques for posterior urethral valves ablation have been refined and the short-term management of patients with posterior urethral valves has improved remarkably, there is growing concern about the long-term outcome. At present endoscopic fulguration with observation is the treatment of choice for posterior urethral valves. In this study patients improved dramatically following fulguration of posterior urethral valves. Early diagnosis and appropriate therapy may arrest progressive damage and facilitate recovery. Further follow-up studies of longer duration are needed.
后尿道瓣膜是导致儿童肾衰竭的先天性梗阻性尿路病的最常见原因。本研究旨在根据临床、放射学和实验室检查结果评估后尿道瓣膜内镜电灼术的疗效。本前瞻性研究对50例接受内镜电灼术治疗并前来进行常规随访的患有后尿道瓣膜的男童进行。通过排尿性膀胱尿道造影（VCUG）确诊后尿道瓣膜（PUV）。瓣膜切除术后，在所有病例的1、3、6、12个月时以及之后最长至3年每6个月进行一次尿R/M/E、尿培养及药敏试验、血清肌酐水平、包括残余尿量（PVR）的肾脏、输尿管、膀胱超声（USG of KUB）检查。患者的平均年龄为2岁，年龄范围为1至12岁。瓣膜切除术后的平均随访期为30.48个月。诊断时平均血清肌酐+/-标准差为90.4+/-44.8μmol/L，在3年随访结束时降至56.3+/-11.1μmol/L。肾积水改变从84%降至4%。蛋白尿从38%降至6%，尿路感染在最终随访结束时从58%降至4%。尽管后尿道瓣膜切除技术已得到改进，后尿道瓣膜患者的短期管理也有显著改善，但对长期疗效的担忧日益增加。目前，内镜电灼并观察是后尿道瓣膜的首选治疗方法。在本研究中，患者在后尿道瓣膜电灼术后显著改善。早期诊断和适当治疗可能阻止病情进展并促进恢复。需要进行更长时间的进一步随访研究。
