Jaidurairaj, P (2011) A Study on short term outcome and prognosis of primary & delayed fulguration in posterior urethral valve. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : PUV is the most common cause of Lower Urinary Tract obstruction in male neonates. The incidence is I in 4000- I in 7500 births PUV occur exclusively in males. This disease has a broad spectrum of presentation. They may present at any age during childhood & may vary from ascites in the neonate to renal failure in infant and only minor voiding dysfunction in an older child. Urinary tract infection is common at all ages. Oligohydramninos & hydronephrosis detected by antenatal ultrasound may be associated renal dysplasia which may compromise renal function despite relief of obstruction. The diagnosis is made by ultrasound & micturating cystourethrography. To know the renal status and to evaluate the Urinary tract infection. Sr. Creatinine, blood urea & urine c/s will give a clue. Surgical care of the patient with PUV varies according to age, bladder status & renal status ideal treatment involves trans urethral ablation using electro cautery of the PUV(Fulguration). When Urethral size precludes valve ablation,a vesical (i.e. vesicostomy) or supra-vesical (ureterostomy)diversion can be created to provide upper tract drainage. Bilateral Ureterostomy can also be placed for urinary drainage in certain condition. PUV present with wide spectrum of renal & bladder pathology including damage to renal parenchyma as well as to smooth muscle function of urinary bladder. These changes may persist despite successful management of the primary obstructing PUV leading to bladder dysfunction & renal insufficiency, which is the primary cause of morbidity & mortality in these children. Much work has been done to identify the factors that predict the final outcome in these cases so as to prognosticate the end result and implicated the correct treatment protocol. This study reviews retrospectively a series of 35 children with posterior urethral valves who completed all stages of treatment presented at our institute over the last 3- 5 years with an aim to identify the prognostic factors prospectively. AIM AND OBJECTIVES : 1. To assess the impact of primary impaction on Short term outcome. 2. To assess the outcome of diversion and delayed Fulguration. 3. To test the efficiency of the treatment. 4. To identify the prognostic factors. 47 CONCLUSION : The incidence of renal insufficiency in children with posterior urethral valves in this series was 38% (30-45%) with an average follow up period of 3 years . Factors important in prognosticating the progression towards renal insufficiency & bladder dysfunction were : 1. Age at intervention more than 2 yrs . 2. Serum creatinine more than .8%. 3. Recurrent urosepsis . >3 episodes/year. 4. Bilateral high grade reflux . 5. Bilateral parenchymal damage as seen onb ultrasonography. 6. Urodynamics is of immense help in cases having symptoms inspite of good stream .the use of anticholinergics for abnormal urodynamics gives encouragingresults.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | short term outcome ; prognosis of primary ; delayed fulguration ; posterior urethral valve. |
| Subjects: | MEDICAL > Paediatric Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 28 Jul 2017 03:02 |
| Last Modified: | 28 Jul 2017 03:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2293 |
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