Churchill B M, McLorie G A, Khoury A E, Merguerian P A, Houle A M
Department of Surgery, University of Toronto, Ontario, Canada.
Urol Clin North Am. 1990 May;17(2):343-60.
Posterior urethral valves have a broad spectrum of clinical severity determined by the degree and reversibility of the long stepwise sequence of secondary pathology. Neonatal azotemia and severe bilateral reflux are particularly important negative prognostic factors. In the mild cases, valve ablation with or without delayed reconstruction is good therapy. In the very severe cases, our interpretation of all the clinical and experimental information now available suggests that the time interval and the level of decompression are extremely important. Achievement of consistent low caliceal pressure without stasis and infections should be achieved as soon as possible. We do not agree with the philosophy of "valve ablation and wait and see" for secondary reconstruction as applied to the severe cases. An analogous philosophy would be treating all respiratory infections as upper respiratory infections and applying aggressive appropriate therapy for pneumonia only if the patient does not respond clinically. However, all controversy aside, the management of neonatal infants with posterior urethral valves remains a difficult and challenging problem for us all. The real challenge will be to improve published management results to the point that the family faced with decisions regarding an in utero diagnosis of posterior urethral valves will have enough hope to continue the pregnancy.
后尿道瓣膜症具有广泛的临床严重程度，这取决于继发病理长期逐步发展过程的程度及可逆性。新生儿氮质血症和严重双侧反流是特别重要的不良预后因素。在轻度病例中，无论是否进行延迟重建，瓣膜消融都是有效的治疗方法。在非常严重的病例中，我们对目前所有可用的临床和实验信息的解读表明，减压的时间间隔和水平极其重要。应尽快实现持续的低肾盂压力，且无淤积和感染。我们不同意将“瓣膜消融并观望”的理念应用于严重病例的二期重建。类似的理念是将所有呼吸道感染都当作上呼吸道感染来处理，只有在患者临床无反应时才对肺炎采取积极的适当治疗。然而撇除所有争议不谈，对于我们所有人来说，新生儿后尿道瓣膜症的管理仍然是一个困难且具有挑战性的问题。真正的挑战将是改善已公布的治疗结果，使面临关于子宫内诊断后尿道瓣膜症决策的家庭有足够的希望继续妊娠。
