Question of the Week

Question :
Posted On : 09 Jan 2019
I am working as Medical Officer in Purulia Sadar Hospital.
My child {current age 2 year and 3 month} is suffering from Posterior urethral valve.
He had 2 documented UTI at age of 11 month and 2 year and 1 month.
His Serum creatinine:o.6mg, dl at age 1yr 6 month
:0.6mg, dl at age 2yr 1 month
:o.4mg, dl at age 2yr 2 month before
His USG and DTPA Scan{done at age 13 month}report :with in normal limit.
His DTPA Scan report:Both kidney are of average size and shape with normal perfusion and no obstruction seen in either kidney.Total GFR:114.14ml, min
MCU Report:Posterior urethra is dilated with residual urine in bladder but no reflux.
Cystoscopy and valve ablation done at age of 2yr 2 month
His urinary stream is improved after cystoscopy.He is under prophylactic antibiotic {Cotrimoxazole}till first attack of UTI i.e.11 month.
I have the following questions
1.How the chance of residual valve or stricture can be excluded_?
2.Is Urodyanomic study is required_?-if required any centre for urodyanomic study in Kolkata in this age group.
3.How long the prophylactic antibiotic to be continued_?
4.Prognosis of my child in future{chance of Renal failure}
Expert Answer :
Dear Parent,
Phew!!! Lots of details and lots of questions, lets take one at a time. One of the ways to confirm complete ablation of valves is a Check Cystoscopy at 6 weeks from the first. Also doing a post void residue by USG may help to confirm that he is passing urine and emptying his bladder. Urodynamic study ideally is indicated but is an invasive study. This will help to look for Detrusor instability if present, uroflo to look for residual obstruction, compliance of the bladder and based on all the reports, the necessity for Anticholinergic drug to be started.No idea about Calcutta where it may be done. Since your boy has no reflux, antibiotics for 6 weeks followed by urine examination weekly for 3 weeks and then fortnightly may be helpful. Since his Naddir Creatinine at age 1 year has been less than 0.1 overall prognosis is great. However, a note of caution to regularly follow up with your Pediatric Urologist doing USG and may be MCU and DMSA Scan from time to time. Notorious time is around 10 years and agagin before puberty. Regards,
Dr Vivek Rege
Answer Discussion :
George M
mild exclusive procedure,most times urodyanomic study may be required.the chance of renal failure for the future is slim
2 years ago

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