Kajbafzadeh Abdol-Mohammad, Hosseini Sharifi Seyed Hossein, Keihani Sorena, Soltani Mohammad Hossein, Tajali Afshin, Salavati Alborz, Payabvash Seyedmehdi, Mehdizadeh Mehrzad
Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
Int J Urol. 2015 May;22(5):514-9. doi: 10.1111/iju.12712. Epub 2015 Feb 16.
To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves.
We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded.
From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients.
Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves.
报告我们对合并前后尿道瓣膜患者进行内镜治疗的12年经验。
我们回顾性分析了2000年至2012年转诊至我院接受尿道瓣膜治疗的患者病历，以找出合并前后瓣膜的病例。瓣膜的诊断首先通过排尿性膀胱尿道造影怀疑，并经尿道膀胱镜检查证实。我们收集了患者诊断时的年龄、临床表现、超声和尿动力学检查结果以及手术治疗等可用数据。还记录了最后一次随访时的最终结果。
在38例前尿道瓣膜患者中，6例（15.8%）合并前后瓣膜。这些患者的诊断年龄从产前诊断到13岁不等。最初的症状表现为反复尿路感染、尿失禁、尿脓毒症和尿流不畅。所有瓣膜均使用小型尿道膀胱镜经尿道电灼/切除。在合并前后瓣膜的患者中，4例在就诊时存在膀胱输尿管反流，其中2例在瓣膜切除后反流消失。1例进展为肾衰竭，需要透析。膀胱高收缩性和逼尿肌过度活动是这些患者主要的尿动力学表现形式。
合并前后瓣膜似乎比之前认为的更为常见，且可能在初次评估时被漏诊。当怀疑有梗阻时，能完整显示尿道的斜位排尿性膀胱尿道造影对诊断至关重要。随后应进行细致的尿道膀胱镜检查以确诊并对瓣膜进行内镜切除。
