Trends of treatment for posterior urethral valves / 中华实用儿科临床杂志

ABSTRACT

Posterior urethral valves(PUV) is the most common cause of lower tract obstruction in boys.With the understanding of the prognostic factors of PUV in depth,PUVs can have a profound effect on the function of bladder and upper urinary tract though valves are completely resected.The treatments of PUV include prenatal intervention,the antenatal vesicoamniotic shunt and fetal cystoscopy can be considered in selected patients with oligohydramnios.But the role of antenatal intervention is unclear.The gold standard for postnatal treatment of PUV is valve ablation.Vesicostomy is reserved primarily for the children with PUV whose urethra cannot accommodate an endoscope, as well as have severe urinary tract infections.Circumcision should be encouraged as a prophylactic measure for children with PUV who should have high rate of urinary tract infection.Vesicoureteral reflux is very common in PUV patients, and life-long monitoring of these patients is mandatory, as bladder dysfunction and valve bladder may be found during follow-up.These factors contribute toward the devolution of a bladder into dysfunction status are high voiding pressures and increased residual urine.Medication and clean intermittent catheterization are two main interventions, for the children who difficult to treat, an appendicovesicostomy utilizing the Mitrofanoff principle presents an useful option.Renal transplantation is an alternative for patients with PUV who progress to end-stage renal disease.Bladder dysfunction plays an important role in the development of PUV and urodynamic examination can be used to assess the function of the bladder to achieve timely and effective intervention.