Rawat Jiledar, Khan Tanvir Roshan, Singh Sarita, Maletha Madhukar, Kureel Shivnarain
Department of Pediatric Surgery, CSM Medical University (Upgraded KGMC), Lucknow, Uttar Pradesh, India.
Afr J Paediatr Surg. 2009 Jul-Dec;6(2):102-5. doi: 10.4103/0189-6725.54773.
Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula.
We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient.
The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections.
We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.
前尿道瓣膜（AUVs）是一种罕见的先天性异常，可导致儿童下尿路梗阻。尽管它们被称为瓣膜，但这些梗阻性结构通常以憩室的形式出现。在这些病例中，尿道表现为囊状或球部扩张，称为前尿道憩室（AUD）。它们通常发生在海绵体有缺陷的部位，留下薄壁尿道。在排尿时，这部分尿道会膨出，类似一个肿物，有时在阴茎腹侧可见。肿胀有波动感，压迫时尿液会从尿道口滴出。本研究重点介绍了识别该病症的临床方法及其治疗选择，特别是对于那些出现尿道憩室的患者。
我们研究了患有先天性前尿道瓣膜和憩室的儿童。2000年至2007年期间，收治了6例伴有憩室的AUVs患者，并对其进行了前瞻性评估。平均就诊年龄为16个月（15天至4岁）。排尿时用力和可触及的阴茎肿胀是最常见的就诊特征。通过排尿性膀胱尿道造影（VCUG）确诊，并通过超声检查（USG）辅助诊断。除1例因尿脓毒症术前死亡外，所有患者均接受了一期开放性手术切除。1例患者进行了阴茎阴囊尿道的初始切开和延迟修复。
除1例因严重的背压改变、尿腹水和尿脓毒症延迟就诊死亡外，所有患者手术均成功。长期随访显示，所有患者尿流良好。肾功能正常，患者无尿路感染迹象。
我们认为，与后尿道瓣膜患者相比，AUVs患者若治疗不过度延迟且一般状况良好。通过VCUG可轻松确诊，超声检查可显示严重程度。开放性手术切除是尿道憩室患者的首选治疗方法；然而，在部分患者中，膀胱镜电灼术也是可行的。手术效果极佳，发病率和死亡率极低。
