PU valves
 
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Author: Sudipta Das
Question
I am treating a boy who is now 3 year old. At the age of 8 month he was presenting with poor weight gain and urinary tract infection {UTI}. He was diagnosed as a case of posterior urethral valve {PU valves} after micturating cystourethrogram {MCU} by Pediatric Surgeon. He was undergone cystoscopy 3 times. But even after that his posterior urethra is dilated. He is currently 13 kg with height of 95 cms. I am interested to know about further management and prognosis of the baby.

Past History: At 8 months of age, diagnosed as UTI. At 11 months, USG abdomen normal. At 13 months of age, urinary bladder dilated on USG and DMSA scan shows minimal parenchymal inflammation. There is no scintigraphic evidence of scaring in either kidney. At the age of 18 month 1st MCU done, suggestive of dilated posterior urethra, post void residual urine present but no reflux is noticed. Cystoscopy done and flimsy cusp at right side noted which was fulgurated. Both ureteric openings are normal. DTPA Scan done one and half month after first cystoscopy was normal. Second MCU done 7 month after first cystoscopy which shows normal urinary bladder with dilated posterior urethra. No VUR. Post void skiagram shows large amount of residual urine. Second cystoscopy done and PU valve is fulgarated at 5,7,12 o’ clock position. Third cystoscopy done 5 month after 2nd cystoscopy and fulguration of residual valve done in 12 o’clock position. Third MCU done 4 months at 3 years of age shows dilated posterior urethra withour reflux {figure attached}. Serum creatinine on several occasions is normal and urine on several occasions is normal except at age of 2 year and 1 month urine culture shows colony count 80000. Clinically child’s urinary flow is improved after second cystoscopy. He is on prophylactic antibiotic from his first attack of UTI i.e. 11 month of age till now.
Answer Discussion :
G
Gundewar Vivek
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Regular urin examination to detect uti most of these children develop CRF in 2nd or 3rd decad.
6 years ago
C
Cheentan Singh
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This is a milder version of PUV
1} Ensure that Sr Cr and Phosphate is corrected for age to be sure that its normal
2} You may check PTH to be sure that there is no secondary hyperparathyroidism {which is the case in many}
3}He would need a urodynamic assessment with flow rate, bladder capacity and post void residual to assess bladder function
4}If there is no residual and no reflux then prophylaxis could be stopped with a low threshold of doing urine culture for suspected UTIs
5} If this is the case than all he needs is regular monitoring of growth failure, UTI, anemia, worsening renal function with growth.

6 years ago

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