Chang Y Y, Peng H C, Chen H C, Chang W T, Yang C R
Division of Urology, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Jun;55(6):485-90.
From 1985 to 1993, five male patients with posterior urethral valves were treated at our hospital; they included three newborns, a 32-month-old and a 10-year-old child. On initial examination, all patients showed severe bilateral hydronephrosis and hydroureter on sonographic findings, dilatation of the prostate urethra and trabeculation of the bladder wall in the voiding cystourethrogram; only one patient showed vesicoureteral reflux. Type I urethral valves were present in all patients. Retrograde transurethral ablation of the valves was performed in four patients with good preoperative renal function. The postoperative courses were smooth except for vesicoureteral reflux in one patient and systemic fungus infection in another. Reimplantation of the ureter was done for the vesicoureteral reflux, and the fungus infection was treated by amphotericin B. Cutaneous vesicostomy was performed for a newborn since the urethral orifice was small. He presented with poor renal function and ascites. Delayed antegrade ablation of the valves per vesicostomy and closure of the vesicostomy were done three months later after restoration of the renal function. Renal function returned to normal after operation in all patients, but the function of the upper urinary tract and bladder continence need long-term follow-up.
1985年至1993年，我院共收治5例后尿道瓣膜症男性患者，其中包括3例新生儿、1例32个月大的幼儿及1例10岁儿童。初诊时，超声检查发现所有患者均有严重的双侧肾积水及输尿管积水，排尿性膀胱尿道造影显示前列腺尿道扩张及膀胱壁小梁形成；仅1例患者存在膀胱输尿管反流。所有患者均为I型尿道瓣膜。4例术前肾功能良好的患者接受了经尿道逆行瓣膜切除术。除1例患者出现膀胱输尿管反流，另1例发生全身性真菌感染外，术后病程顺利。针对膀胱输尿管反流进行了输尿管再植术，全身性真菌感染采用两性霉素B治疗。1例新生儿因尿道口狭小，行皮肤膀胱造瘘术。该患儿肾功能差且有腹水。3个月后，待肾功能恢复，经膀胱造瘘口进行了延迟性顺行瓣膜切除术，并关闭了膀胱造瘘口。所有患者术后肾功能均恢复正常，但上尿路功能及膀胱控尿功能仍需长期随访。
