Posterior Urethral Valve Management - A Review of 104 cases.

Mohankumar, K (2007) Posterior Urethral Valve Management - A Review of 104 cases. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION : Posterior urethral valve (P.U.V) represents the most common cause of congenital obstructive uropathy leading to childhood renal failure. The incidence of P.U.V. is approximately 1:5000 to 1:8000 infant males. Challenges posed by children with P.U.V are multiple. Obstruction by valves is a process which involves the entire urinary system. So the surgeons involved in the acute and long-term care of these patients are faced with the challenging management problems that are multiple and interdependent. Appropriate clinical suspicion remains the key to diagnosis which is confirmed by standard imaging techniques. Initial therapy usually consists of skillful endoscopic work to remove the obstruction. The outcome is however far from determined at this point. The risk of renal compromise and ultimate renal failure is a potential problem for each patient. This outcome may be altered by appropriate intervention, but in most cases the renal development in utero determines the need for eventual dialysis or transplant. In the past, the treatment of P.U.V was based primarily on the mechanism of obstruction and its relief. The current treatment of P.U.V. is based upon our evolving knowledge of the consequences of bladder outlet obstruction on our patients renal health and is enhanced by continuous, long term follow-up. AIMS : 1. To analyze our experience with the management of PUV and to study the short term outcome of patients managed at our institution. 2. To analyze the different modalities of treatment and to choose the best among them. 3. To determine the complications and follow-up criteria of PUV. 4. To determine the prognosis of our antenatally detected Patients. METHODS : In our study of 104 patients of P.U.V, 34 (32.70%) cases presented in the neonatal period, 31 (29.80%) cases between 1 to 12 months of age , 24 (23.08%) patients in the 1 to 5 year age group and 15 (14.42%) were of 5 to 12 years of age. 8 patients were diagnosed antenatally. Among the 104 patients, 47 were treated by Primary endoscopic valve fulguration and the remaining cases underwent urinary diversion either in the form of vesicostomy in 45 patients or ureterostomy in 9 patients. We have analyzed the results and have presented the discussion with a brief review of literature, follow-up and recommendations. CONCLUSION : The following conclusions were arrived at 1. Though technically demanding primary fulguration seems to be a promising method for managing PUV irrespective of age. The benefits of primary fulguration are: a. Length of hospital stay is reduced, b. Cost effective, c. Lesser number of surgeries, d. Scarless, e. Parent's psychological trauma is lessened. 2. We could avoid urinary diversion in 42.30 percentage of our cases. 3. Urosepsis and increased serum creatinine are not absolute contraindications for primary fulgurations. 4. Outcome of patients with PUV depends upon initial renal status irrespective of management options used. 5. So it is better to fulgurate as a single stage than going in for diversion which involves many stages. 6. The prognosis of antenatally detected patients was dismal in our study. 7. Patients should be referred at the earliest to tertiary centres which have facilities for fulguration. 8. Long term follow-up is a must going by the prognostic indicators with special attention to bladder dynamics.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Posterior Urethral Valve ; Management ; Case study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:09
Last Modified: 31 Jul 2017 04:09
URI: http://repository-tnmgrmu.ac.in/id/eprint/2360

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