Belloli G, Musi L, Valli F, Silva A, Rosselli G, Pecenco G
Pediatr Med Chir. 1985 Sep-Oct;7(5):653-62.
In this paper the authors have analyzed the management and the outcome of 81 cases of posterior urethral valves which occurred during the period January 1972 - April 1985. 53 children presented very severe urethral valves (grade 4 according to Hendren), 28 mild valve type. All the children of the first group but two had a dilatation of the U.U.T. Vesico-renal reflux, usually severe, was present in 51 ureters; in another 50 ureters a dilatation without reflux was present. 47% of the children of the first group had a renal function within the limits of normality at the moment of presentation and the remaining 53% a reduced renal function. In 9 patients (8 under 50 days of age) a cutaneous vesicostomy according to Blocksom followed, at the age of 10-18 months, by transurethral valve destruction was done. In 6 infants, in the early part of the series, the valve was removed with a hook via the perineal approach. In 38 patients we performed a transurethral valve destruction with the n. 3 Bugbee electrode. 36 out of 53 children (68%) had exclusively a removal of the valvular obstruction. After the removal of the obstruction, 32 out of 37 non refluxing dilated ureters (86.5%) showed a clear improvement. In 7 out of 29 refluxing ureters a nephrectomy was carried out. In the remaining 22 ureters the reflux vanished in 17 and improved in the other 5. 17 children had other types of operations after valvular removal. 23 ureters in 13 patients were reimplanted, with 3 failures (13%). In the 53 children with very severe valve (grade 4) supravesical diversions were not carried out. In the follow-up of 51 children (from 6 month to about 14 years) the renal function was within the limits of normality in 74% (before the operation it was 47%). The best results were obtained in children diagnosed and treated in the first months of life. Cutaneous vesicostomy showed itself to be a very useful method of treatment in very young babies with severe complications. We observed a slight terminal urethral stricture, easily dilatable, in only 1 child. All the children over the age of 12-13 years were continent. In 28 children with mild valves, as well as transurethral valve destruction, an ureteric reimplantation was carried out with success in 5 children (8 ureters) and a vesical diverticulectomy in another 2.
在本文中，作者分析了1972年1月至1985年4月期间发生的81例后尿道瓣膜症的治疗及预后情况。53例患儿患有非常严重的尿道瓣膜（根据亨德伦分级为4级），28例为轻度瓣膜类型。第一组中除2例患儿外，其余均存在上尿路扩张。51例输尿管存在膀胱-肾反流，通常较为严重；另有50例输尿管存在无反流的扩张。第一组中47%的患儿在就诊时肾功能正常，其余53%的患儿肾功能减退。9例患儿（8例年龄小于50天）先进行了布洛克索姆式膀胱造瘘术，在10至18个月大时再行经尿道瓣膜损毁术。在该系列研究早期，有6例婴儿经会阴途径用钩子摘除了瓣膜。38例患者我们使用3号布格比电极行经尿道瓣膜损毁术。53例患儿中有36例（68%）仅解除了瓣膜梗阻。解除梗阻后，37例无反流的扩张输尿管中有32例（86.5%）明显改善。29例有反流的输尿管中有7例行肾切除术。其余22例输尿管中，17例反流消失，5例有所改善。17例患儿在瓣膜摘除术后还进行了其他类型的手术。13例患者的23条输尿管进行了再植，3例失败（13%）。53例患有非常严重瓣膜（4级）的患儿未进行膀胱上分流术。在对51例患儿（随访时间从6个月至约14岁）的随访中，74%的患儿肾功能正常（术前为47%）。在出生后最初几个月被诊断并接受治疗的患儿中取得了最佳效果。膀胱造瘘术对患有严重并发症的非常小的婴儿来说是一种非常有用的治疗方法。我们仅在1例患儿中观察到轻微的尿道末端狭窄，易于扩张。所有12至13岁以上的患儿均能自主排尿。28例患有轻度瓣膜的患儿，除了经尿道瓣膜损毁术外，5例患儿（8条输尿管）成功进行了输尿管再植，另有2例进行了膀胱憩室切除术。
