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He Y, Lin SB, Li W, Sun Y, Tang L, Zhang R. Case Report: Neonatal Urinary Ascites Without Hydronephrosis: A Rare Case of Anterior Urethral Valve and Diverticulum in Preterm Newborn. Front Pediatr 2022; 10:920817. [PMID: 35844749 PMCID: PMC9280888 DOI: 10.3389/fped.2022.920817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
The deformation of congenital obstruction of the anterior urethra is rare in male infants. The anterior urethral valve (AUV) and diverticulum are not common causes of distal urethral obstruction, which may be significant but difficult to diagnose in time. We describe a premature infant who was diagnosed with AUV as part of a diverticulum in the anterior urethra and was presented as massive urinary ascites without hydroureters and hydronephrosis. After indwelling abdominal tube and urinary catheterization, the infant's massive ascites were resolved, while urethral obstruction had successful treatment by Holmium laser. We suggest that the presence of urinary ascites in fetuses and neonates should be considered as a warning against urinary malformations.
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Affiliation(s)
- Yue He
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Sam Bill Lin
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - WenXuan Li
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - YuBo Sun
- Department of Urology, Children's Hospital of Fudan University, Shanghai, China
| | - LiangFeng Tang
- Department of Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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2
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Chibani I, Nouira F, Marzouki M, Ben Ahmed Y, Boukesra T, Charieg A, Jlidi S. Congenital anterior urethral diverticulum presenting as a scrotal mass. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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3
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Sørensen FE, Skott M, Rawashdeh YF, Kirkeby HJ. Syringocele: a retrospective study and review of the literature. Scand J Urol 2019; 53:269-274. [PMID: 31411088 DOI: 10.1080/21681805.2019.1649719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A syringocele is a cystic dilation of the ducts from the bulbourethral glands located in the bulbous part of the male urethra. It is a rare condition primarily reported in children and young adults. The objective was to evaluate the diagnostic pattern and management strategy in patients of all ages diagnosed with syringocele.Methods: A retrospective review of patients with syringocele in the period 2004-2018 was performed. Age at diagnosis, primary symptoms, the diagnostic modalities used, treatments and effects were registered.Results: In the period, 19 patients with syringoceles were identified, eight children and 11 adults. The majority of the patients presented with obstructive voiding symptoms. All patients underwent cystourethroscopy. Supplementary diagnostics as voiding cystourethrography, retrograde urethrography, uroflowmetry, magnetic resonance imaging or transrectal ultrasonography were used inconsistently. Sixteen of the patients underwent marsupialization, one child underwent open excision and two patients were managed conservatively. Three of the children were re-operated on with endoscopic marsupialization. One of the adult patients did not respond to marsupialization and was treated with and vesico-appendico-cutaneostomy.Discussion: A review of the case reports published in the period 1996-2018 was performed and compared to these results. This review found 77 cases, 50 children and 27 adults. The reported symptoms, diagnostics and treatments were in line with the findings of this study.Conclusions: Based on these findings and the literature it is recommended that syringoceles should be diagnosed by cystourethroscopy and urethrography. Patients with symptomatic syringoceles should be offered treatment. First line treatment is endoscopic marsupialization.
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Affiliation(s)
| | - Martin Skott
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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4
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Diverticule congénital de l’urètre antérieur chez l’enfant : à propos d’un cas. Prog Urol 2017; 27:448-449. [DOI: 10.1016/j.purol.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 11/22/2022]
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5
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Blasl F, Rösch WH, Koen M, Ardelean MA, Ebert AK. Cowper's syringocele: A rare differential diagnosis of infravesical obstruction in boys and young adults. J Pediatr Urol 2017; 13:52.e1-52.e5. [PMID: 27746247 DOI: 10.1016/j.jpurol.2016.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 08/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE AND INTRODUCTION Cowper's syringocele is a cystic dilation of the bulbourethral gland duct, initially defined by Maizels et al. in 1983. Although obstructive and non-obstructive types of this rare anomaly are described, clinical symptoms are highly unspecific. Therefore, we report 12 cases of children and young adults diagnosed with Cowper's syringocele to further clarify clinical course, comorbidity and treatment strategies. STUDY DESIGN We retrospectively collected clinical data of 12 children and young adults from birth to 18.5 years (median 7.2 years) who had been treated in four different institutes during a period of 16 years. The primary specific diagnostic work-up consisted of ultrasound, cystourethrography, and cystoscopy. RESULTS 3Older patients with a median age of 11.8 years clinically presented with obstructive voiding pattern or gross hematuria; infants with a median age of 0.6 years presented with febrile urinary tract infections (UTIs). After cystoscopic confirmation in all patients, endoscopic treatment was possible in nine; open surgical resection was necessary in three patients. Because of intrauterine megacystis and chronic renal failure, one boy underwent suprapubic diversion with a cystostomy soon after birth. Owing to urological comorbidity or later complications, additional procedures were necessary, for example, resection of minor urethral valves, prophylactic circumcision for UTI, endoscopic or open antireflux procedures, and occasionally complex bladder reconstructions in the long term. DISCUSSION According to our data, the initial clinical symptoms of Cowper's syringocele were related to presenting age rather than the previously described type of syringocele according to Maizels et al. Infants presented with febrile UTIs; however, older boys and young adults had mainly voiding problems or nocturnal enuresis. Therefore, the clinical significance of the described syringocele types must be questioned. Eighty-three percent of our patients showed additional urological pathology such as vesicoureterorenal reflux, ureteropelvic junction obstruction, megaureter, or minor urethral valves. Thus, Cowper's syringocele hardly seems to be an isolated pathology. CONCLUSION Although rare, Cowper's syringoceles should be considered in differential diagnosis of infravesical obstruction in boys and young adults. Diagnostics are usually justified by presenting symptoms such as UTI or urinary flow impairment, which seem to be age dependent. Despite modern diagnostic tools, diagnosis is usually made by cystourethrography and sometimes accidentally by cystoscopy. Considerable urological comorbidities and consecutive bladder dysfunction need long-term follow-up.
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Affiliation(s)
- Felix Blasl
- Department of Urology, Katharinenhospital, Stuttgart, Germany.
| | - Wolfgang H Rösch
- Department of Pediatric Urology, University Medical Center, Regensburg, Germany
| | - Mark Koen
- Department of Pediatric Urology, Krankenhaus Barmherzige Schwestern, Linz, Austria
| | | | - Anne-Karoline Ebert
- Department of Urology and Pediatric Urology, Medical University Ulm, Ulm, Germany
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6
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Gürağaç A, Irkilata HC, Yunusov N, Demirer Z. Congenital anterior urethral diverticulum presenting as a scrotal mass in a two-year-old child. Can Urol Assoc J 2017; 10:E395-E397. [PMID: 28096926 DOI: 10.5489/cuaj.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Here, we describe a case of congenital anterior urethral diverticulum (CAUD) in a two-year-old boy, who presented with right inguinoscrotal swelling that mimicked a spermatic cord cyst or hydrocele. Accurate diagnosis was made intraoperatively by retrograde urethrography. Open diverticulectomy and primary urethroplasty were performed for its management. The clinical presentation, diagnosis, and the management of this rare condition is discussed.
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Affiliation(s)
- Ali Gürağaç
- Tatvan Military Hospital, Department of Urology, Bitlis, Turkey
| | - Hasan Cem Irkilata
- Gülhane Military Medical Academy, School of Medicine, Department of Urology, Ankara, Turkey
| | - Nahit Yunusov
- Gülhane Military Medical Academy, School of Medicine, Department of Urology, Ankara, Turkey
| | - Zafer Demirer
- Eskisehir Military Hospital, Department of Urology, Eskisehir, Turkey
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7
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Saha M. Congenital anterior urethral diverticulum: A case report. J Indian Assoc Pediatr Surg 2015; 20:198-9. [PMID: 26628815 PMCID: PMC4586986 DOI: 10.4103/0971-9261.154642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manoj Saha
- Department of Pediatric Surgery, Gauhati Medical College, Guwahati, Assam, India
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8
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Keihani S, Kajbafzadeh AM. Concomitant Anterior and Posterior Urethral Valves: A Comprehensive Review of Literature. Urology 2015; 86:151-7. [DOI: 10.1016/j.urology.2015.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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9
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Congenital anterior urethral diverticulum: antenatal diagnosis with subsequent neonatal endoscopic management. Urology 2015; 85:914-7. [PMID: 25704997 DOI: 10.1016/j.urology.2014.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/04/2014] [Accepted: 12/08/2014] [Indexed: 11/22/2022]
Abstract
Congenital anterior urethral diverticulum is a rare cause of urethral obstruction in boys. We report on the antenatal diagnosis of this rare phenomenon, making this the sixth prenatally diagnosed case in the English literature (to the best of our knowledge). Our initial prenatal assessment, postnatal endoscopic management, along with the eventual clinical course is outlined. The embryologic theories, differential diagnosis, literature review, imaging, and treatment modalities of this entity are discussed.
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10
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Vásquez B, Sol MD. Estereologia das glândulas bulbouretrais do coelho (Oryctolagus cuniculus) e da cobaia (Cavia porcellus). PESQUISA VETERINARIA BRASILEIRA 2014. [DOI: 10.1590/s0100-736x2014001200018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As glândulas bulbouretrais (GBU) no coelho (Oryctolagus cuniculus) e na cobaia (Cavia porcellus) desempenham um papel importante na fisiologia reprodutiva. No entanto, seus aspectos histológico e estereológico são escassos. Assim, o objetivo desta pesquisa foi comparar características estereológicas entre as GBU do coelho e da cobaia como um primeiro passo para a compreensão das variáveis morfométricas que participam nos processos reprodutivos. Foram utilizados 5 coelhos e 5 cobaias adultos machos, saudáveis, obtidos do Biotério da Universidade de La Frontera, Temuco, Chile. A região pélvica foi dissecada isolando-se a GBU de cada animal. Determinou-se o peso e o volume de cada glândula. Estas foram fixadas em formalina tamponada durante 24 horas e incluídas em paraplast. Cortes seriados de 4 μm de espessura foram corados com HE para análise estereológica. A média de células glandulares na GBU do coelho foi 19,50 x 10(5)mm³ (DP 2,35) e da cobaia 10,57 x 10(5)mm³ (DP 2,07) e a porcentagem média de tecido glandular foi de 25,52% (DP 2,20) e 17,20% (DP 3,33), respectivamente. Todos os parâmetros estereológicos comparados tiveram uma diferença estatisticamente significativa (p<0,0001). Estas diferenças poderiam ser explicadas porque há maior proximidade celular do epitélio secretor, menor diâmetro do lúmen dos ácinos e da relação núcleo citoplasma na GBU do coelho. Assim, os ácinos da GBU apresentam maior quantidade de células por mm³ do que na GBU do coelho. Estes parâmetros podem ser influenciados por fatores hormonais, etários, sazonais e ambientais, entre outros. Considerar as características morfológicas da GBU nesses animais poderia condicionar o êxito da reprodução por parte do macho.
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Affiliation(s)
- Bélgica Vásquez
- Universidad de Tarapacá, Chile; Universidad de La Frontera, Chile
| | - Mariano del Sol
- Universidad de La Frontera, Chile; Universidad Autónoma de Chile, Chile
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11
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Singh DV, Taneja R. Anterior urethral valves without diverticulae: a report of two cases and a review of the literature. Congenit Anom (Kyoto) 2014; 54:120-2. [PMID: 24118555 DOI: 10.1111/cga.12032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Abstract
Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification.
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Affiliation(s)
- Dig Vijay Singh
- Department of Urology, Post Graduate Institute of Medical Education & Research, Chandigarh, India; Department of Urology, Indraprastha Apollo Hospitals, New Delhi, India
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12
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Smith GHH, Deshpande AV, Tang RWK. Uncommon causes of anterior urethral diverticula in children: Two cases and review of literature. Urol Ann 2014; 6:75-9. [PMID: 24669129 PMCID: PMC3963350 DOI: 10.4103/0974-7796.127018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/21/2012] [Indexed: 11/04/2022] Open
Abstract
Anterior urethral diverticula are rare in children. Anterior urethral valves and associated diverticulum is the commonly discussed pathological entity in children. There is a lack of awareness among clinicians regarding less common presentations of anterior urethral diverticula in children; which can have a diverse involvement of the urinary tract. This report describes two uncommon presentations of anterior urethral diverticula in children, their diagnoses and management. A systematic differential diagnosis and review of anterior urethral diverticula in children is also presented.
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Affiliation(s)
- Grahame H H Smith
- Department of Urology, The Children's Hospital at Westmead, Sydney, Australia
| | - Aniruddh V Deshpande
- The Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Robert W K Tang
- Department of Urology, The Children's Hospital at Westmead, Sydney, Australia
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13
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Li X, Sa Y, Jin C, Xu Y. Traumatic urethral diverticula: a rare malformation of the male urethra. Urol Int 2013; 90:484-6. [PMID: 23486090 DOI: 10.1159/000346321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
Urethral diverticula are pouches opening into the urethral canal that may be either acquired or congenital. Diverticula of the female urethra are fairly common. However, diverticula of the male urethra are relatively uncommon abnormalities. Clinical manifestation is frequently described with irritative and/or obstructive voiding symptoms or ventral bulging, but manifestation as a scrotal mass is extremely rare. We report a giant urethral diverticulum presenting as a scrotal mass in an adult male.
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Affiliation(s)
- Xu Li
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
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Ranawaka R, Dickson AP. Multiple urethral anomalies: anterior urethral diverticulum, posterior urethral valves, and distal hypospadias. J Pediatr Surg 2013; 48:e5-8. [PMID: 23331841 DOI: 10.1016/j.jpedsurg.2012.09.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 09/14/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
We report an infant with antenatally detected bilateral hydroureteronephrosis and a penile cyst who was eventually diagnosed with an anterior urethral diverticulum (AUD), subcoronal hypospadias, and posterior urethral valves (PUV) after birth. To our knowledge, there are no reports where all three anomalies have been found to coexist. As per urethral catheterisation was difficult, cystoscopy-guided catheterisation was performed. On retracting the complete foreskin, a subcoronal hypospadias was identified. The AUD was resected partially, and during a cystoscopy for completion of AUD resection, a dilated anterior urethra was found collapsed, and thin PUV were identified and divided. He remains well at nine months with an improving renal cortical thickness. The vesicoureteric reflux had resolved.
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Affiliation(s)
- Ravibindu Ranawaka
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
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15
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Cruz-Diaz O, Salomon A, Rosenberg E, Moldes JM, de Badiola F, Labbie AS, Gosalbez R, Castellan MA. Anterior urethral valves: not such a benign condition…. Front Pediatr 2013; 1:35. [PMID: 24400281 PMCID: PMC3864262 DOI: 10.3389/fped.2013.00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/21/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15-30 times less common than posterior urethral valves (PUVs). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV, with less hydronephrosis, and a lower incidence of chronic renal insufficiency (5 vs. 30%). The long-term prognosis of AUVs is not clear in the literature. In this report we describe our experience and long-term follow up of patients with anterior urethral valve. MATERIALS AND METHODS We retrospectively identified 13 patients who presented with the diagnosis of AUVs in our institutions between January 1994 and June 2012. Two patients were excluded: one patient had no follow up after intervention; the other had a follow up <1 year. From the 11 patients included, we evaluated the gestational age, prenatal and postnatal ultrasound findings, voiding cystourethrogram findings, age upon valve ablation, micturition pattern, creatinine, and clinical follow up. RESULTS Between 1994 and 2012 we evaluated 150 patients with the diagnosis of urethral valves. Of this group, 11 patients (7.3%) had AUVs and an adequate follow up. Mean follow up is 6.3 years (2.5-12 years). Five (45.4%) patients had prenatal diagnosis of AUV. The most common prenatal ultrasonographic finding was bilateral hydronephrosis and distended bladder. One patient showed a large perineal cystic mass, which was confirmed to be a dilated anterior urethra. The mean gestational age was 37.6 weeks (27-40 WGA). Postnatally, 90% had trabeculated bladder, 80% hydronephrosis, and 40% renal dysplasia. The most common clinical presentation was urinary tract infection in five patients (45.4%), followed by weak urinary stream found in four patients (36.3%). The age at initial surgical intervention ranged between 7 days and 13 years. Seven (63.6%) patients had primary transurethral valve resection or laser ablation and three patients (27.2%) had primary vesicostomies. One boy (9.1%) had penile urethrostomy with excision of urethral diverticulum. Two (18.2%) patients developed end-stage renal disease. CONCLUSION Anterior urethral valve is a rare congenital entity affecting the genitourinary system in males. Early urinary tract obstruction resulted in end-stage renal disease in 18% of our patient population. In our series, the complication rate and the evolution to renal failure are high and similar to patients with PUV. In patients with AUVs we recommend long-term follow up and close evaluation of patient's bladder and renal function.
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Affiliation(s)
- Omar Cruz-Diaz
- Division of Pediatric Urology, Miami Children's Hospital , Miami, FL , USA ; Joe Di Maggio Children's Hospital , Hollywood, FL , USA
| | - Anahi Salomon
- Servicio de Urologia Pediatrica, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Eran Rosenberg
- Division of Pediatric Urology, Miami Children's Hospital , Miami, FL , USA ; Joe Di Maggio Children's Hospital , Hollywood, FL , USA
| | - Juan Manuel Moldes
- Servicio de Urologia Pediatrica, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Francisco de Badiola
- Servicio de Urologia Pediatrica, Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Andrew Scott Labbie
- Division of Pediatric Urology, Miami Children's Hospital , Miami, FL , USA ; Joe Di Maggio Children's Hospital , Hollywood, FL , USA
| | - Rafael Gosalbez
- Division of Pediatric Urology, Miami Children's Hospital , Miami, FL , USA ; Joe Di Maggio Children's Hospital , Hollywood, FL , USA
| | - Miguel Alfredo Castellan
- Division of Pediatric Urology, Miami Children's Hospital , Miami, FL , USA ; Joe Di Maggio Children's Hospital , Hollywood, FL , USA
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Song JH, Lee MH, Lee JH, Lee CH, Jeon YS, Lee NK, Kim DS. Anterior urethral valve and diverticulum in a neonate with febrile urinary tract infection. Korean J Urol 2012; 53:505-7. [PMID: 22866225 PMCID: PMC3406200 DOI: 10.4111/kju.2012.53.7.505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/14/2011] [Indexed: 12/03/2022] Open
Abstract
Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.
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Affiliation(s)
- Jin Hyun Song
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
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17
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Kkhattala K, Rami M, Elmadi A, Chater L, Mahmoudi A, Bouabadallah Y. Giant urethral diverticulum's caused by traumatic vesicle catheterization in children: a case report. Pan Afr Med J 2011; 10:15. [PMID: 22187597 PMCID: PMC3224068 DOI: 10.4314/pamj.v10i0.72224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 08/26/2011] [Indexed: 11/17/2022] Open
Abstract
Urethral diverticula are saclike dilations of the urethra and are classified as either congenital or acquired. While urethral diverticula are commonly seen in female patients, they are rarely seen in men. The most common etiologies of male acquired diverticula include urethral trauma, stricture, abscess or post-hypospadias repair. We report a case of acquired urethral diverticula caused by a traumatic vesical catheterization in a 6-year old boy and review the literature on the topic.
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Affiliation(s)
- Khalid Kkhattala
- Department of Paediatric Surgery, University hospital of Fez, Fez, Morocco
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18
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Congenital anterior urethral diverticulum in a male teenager: a case report and review of the literature. Case Rep Urol 2011; 2011:738638. [PMID: 22606624 PMCID: PMC3350216 DOI: 10.1155/2011/738638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 07/14/2011] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 13-year-old boy with a congenital anterior urethral diverticulum. This is a rare condition in males which can lead to obstructive lower urinary tract symptoms and urosepsis. Diagnosis is by urethroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Long-term followup is required to check for reoccurrence of the obstruction.
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Routh JC, McGee SM, Ashley RA, Reinberg Y, Vandersteen DR. Predicting Renal Outcomes in Children With Anterior Urethral Valves: A Systematic Review. J Urol 2010; 184:1615-9. [DOI: 10.1016/j.juro.2010.03.119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan C. Routh
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota
| | - Shawn M. McGee
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota
| | - Richard A. Ashley
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota
| | - Yuri Reinberg
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota
| | - David R. Vandersteen
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester and Division of Urology, Children's Hospital of Minnesota (YR, DRV), Minneapolis, Minnesota
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Melquist J, Sharma V, Sciullo D, McCaffrey H, Ali Khan S. Current diagnosis and management of syringocele: a review. Int Braz J Urol 2010; 36:3-9. [DOI: 10.1590/s1677-55382010000100002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2009] [Indexed: 11/22/2022] Open
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Arena S, Romeo C, Borruto FA, Racchiusa S, Di Benedetto V, Arena F. Anterior urethral valves in children: an uncommon multipathogenic cause of obstructive uropathy. Pediatr Surg Int 2009; 25:613-6. [PMID: 19517125 DOI: 10.1007/s00383-009-2393-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Anterior urethral valves (AUVs) are uncommon congenital anomalies causing urethral obstruction in boys. PATIENTS AND METHODS Medical records of 13 children were reviewed retrospectively. Each patient (pt) was evaluated with voiding cysto-urethrogram (VCUG) and renal ultrasonography. Pts older than 5 years performed an uroflowmetry. Serum creatine was determined in all children. RESULTS All pts had difficulty in voiding and eight had recurrent urinary tract infection. Renal function was normal in all pts. VCUG showed filling of Cowper's duct in a pt. In a case, a vesicoureteral reflux was discovered. Uroflowmetry showed a flat trace in all cases. Transurethral endoscopic resection of the valves was carried out in 11 children while open resection was necessary in two children. At serial follow-up, all pts remain symptom-free and uroflowmetry documented regular pattern. DISCUSSION Anterior urethral valves are rare lesions that may create problems at different stages. Some AUVs may result from the obstruction distal lip of a ruptured syringocele. Improvements in endoscopic equipment allow for minimally invasive transurethral resection. Large diverticula are best managed with open diverticulectomy and reconstruction. In newborns with severe altered urinary tract drainage, particularly in low birth-weight infant, a vesicostomy may be necessary.
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Affiliation(s)
- Salvatore Arena
- Unit of Pediatric Surgery, Department of Pediatric Surgery, University of Catania, Catania, Italy.
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22
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Canning DA. Pediatric Urology. J Urol 2007. [DOI: 10.1016/j.juro.2007.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kibar Y, Coban H, Irkilata HC, Erdemir F, Seckin B, Dayanc M. Anterior urethral valves: an uncommon cause of obstructive uropathy in children. J Pediatr Urol 2007; 3:350-3. [PMID: 18947773 DOI: 10.1016/j.jpurol.2007.01.197] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE Anterior urethral valves (AUV) are rare entities generally described in case reports. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. In the present study, we present our experience in four children with AUV along with a literature review. MATERIALS AND METHODS We retrospectively identified four children with AUV presented between 1998 and 2005 at age 4-9 years. RESULTS Hematuria, urinary tract infection and weak voiding stream were the most common symptoms. Voiding cystourethrography (VCUG) confirmed the diagnosis of AUV. On cystourethroscopy, cusp-like valves in the anterior urethra were seen in all children. Transurethral endoscopic resection of the valves was carried out in three children using a pediatric resectoscope. In one child with a massive anterior urethral diverticulum, open resection of the valve, diverticulectomy and urethroplasty were performed. All patients were cured, none had complications as a result of surgery, and all reported a normal urinary stream at follow-up. CONCLUSIONS Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valves should be considered in differential diagnosis of obstructive lesions.
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Affiliation(s)
- Yusuf Kibar
- Gulhane Military Medical Academy, Department of Urology, 06018 Etlik, Ankara, Turkey
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Kajbafzadeh AM, Elmi A, Payabvash S, Sina A, Arshadi H, Sadeghi Z. The urethral valve of Guérin and lacuna magna: clinical presentations and urodynamic findings. Pediatr Surg Int 2007; 23:873-8. [PMID: 17605019 DOI: 10.1007/s00383-007-1966-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2007] [Indexed: 11/24/2022]
Abstract
We described the clinical presentations, radiological findings, urodynamic patterns and endoscopic management in a series of patients with symptomatic lacuna magna (LM). The medical records of 14 boys diagnosed as LM were reviewed, retrospectively. The presence of LM was first diagnosed based on clinical history, physical exam, and radiological findings; then confirmed by urethroscopy. Urodynamic study was performed in 10 boys before and after the procedure. Transurethral incision and fulguration of the valve was performed in all patients. The mean (range) age of patients was 3.1 years (6 months to 8 years). The boys presented with dysuria (n = 9), postvoid dribbling (n = 4), hematuria (n = 3), bloody spotting (n = 3), enuresis (n = 4), and glanular irritation and pain (n = 6). The post-operative period was uneventful in all patients. The symptoms were relieved and repeat radiological exam showed complete resolution of LM in all children by the 3rd post-surgical month. Before the procedure, main urodynamic abnormalities in children were high P(detmax) and detrusor instability that significantly improved within 3-6 months after treatment. Despite evidence suggesting that a LM is a frequent, normal anatomical variant, the valve may cause symptoms such as intermittent hematuria, dysuria, and bloody spotting of underwear. The lesion may be associated with obstructive urodynamic patterns in some children. Endoscopic treatment of patients effectively relieves the symptoms and corrects the urodynamic abnormalities.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Levin TL, Han B, Little BP. Congenital anomalies of the male urethra. Pediatr Radiol 2007; 37:851-62; quiz 945. [PMID: 17572890 PMCID: PMC1950215 DOI: 10.1007/s00247-007-0495-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 03/15/2007] [Accepted: 04/06/2007] [Indexed: 11/17/2022]
Abstract
The spectrum of congenital anomalies of the male urethra is presented. The embryologic basis of each anomaly, when known, is discussed. Clinical and imaging features of each entity are presented.
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Affiliation(s)
- Terry L Levin
- Department of Radiology, Children's Hospital at Montefiore Medical Center, 714 Forest Ave, Mamaroneck, NY 10543, USA.
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26
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Yüksel S, Erdoğan H, Yüksel G, Konca Y, Divanli E. A male infant with bilateral upper urinary tract dilatation and recurrent infection: answer. Pediatr Nephrol 2007; 22:1269-71. [PMID: 17508223 DOI: 10.1007/s00467-007-0506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 03/12/2007] [Accepted: 04/03/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Selçuk Yüksel
- Department of Pediatric Nephrology, Ministry of Health Cekirge Children's Hospital, Bursa, Turkey.
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27
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Kajbafzadeh AM, Payabvash S, Karimian G. Urodynamic changes in patients with anterior urethral valves: before and after endoscopic valve ablation. J Pediatr Urol 2007; 3:295-300. [PMID: 18947759 DOI: 10.1016/j.jpurol.2006.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 11/01/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To retrospectively review a series of children with anterior urethral valves (AUV), with emphasis on patterns of urodynamic change and long-term outcome of endoscopic treatment. PATIENTS AND METHODS We reviewed the medical records of eight patients who had undergone thorough radiological and urodynamic exams before and after treatment. The diagnosis of AUV was based on radiological imaging and confirmed by urethrocystoscopy. The valves were ablated through either transurethral fulguration or resection. The upper urinary tracts were studied by renal scan and ultrasonography before and after the procedure. Bladder function was assessed urodynamically 3 months after surgery. Uroflowmetry was performed as soon as the children were toilet trained. RESULTS Endoscopic ablation of AUV was successful in all cases and no surgical complications occurred. The initial symptoms resolved in all boys. VUR disappeared in two out of three patients, and five children had bladder trabeculation that was resolved after surgery. The final outcome was successful in seven patients (88%). The major urodynamic dysfunction was bladder hypercontractility that resolved following valve ablation. The mean maximum voiding detrusor pressure (P(detmax)) decreased from 213.2+/-17.9 cmH(2)O to 80.7+/-9.9 cmH(2)O, 6 months after treatment (P<0.001). None of the patients had low-compliant bladder, detrusor instability or myogenic failure. The voiding pattern in all toilet-trained patients was staccato and of an interrupted shape prior to surgery, but changed to a normal bell-shaped voiding pattern following valve ablation. CONCLUSION AUV should be considered in the differential diagnosis of patients presenting with infravesical obstruction. We recommend endoscopic valve ablation as the treatment of choice.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Rafique M. Congenital anterior urethral diverticulum in an adolescent boy with obstructive urinary symptoms. Int Urol Nephrol 2007; 39:437-40. [PMID: 17308879 DOI: 10.1007/s11255-006-9055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 05/30/2006] [Indexed: 10/23/2022]
Abstract
A case of anterior urethral diverticulum in a 12 years old boy who presented with obstructive urinary symptoms is described. The diagnosis was made on retrograde urethrography. Open diverticulectomy and urethroplasty was done with complete excision of obstructing anterior valve. The clinical presentation, diagnosis, and management of this rare condition is discussed.
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Affiliation(s)
- Muhammad Rafique
- Nishtar Medical College, 5, Altaf Town, Tariq Road, Multan, Pakistan.
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Coplen DE, Austin PF. Prenatal Diagnosis and Neonatal Management of Congenital Urethral Diverticulum. J Urol 2007; 177:2330-2. [PMID: 17509352 DOI: 10.1016/j.juro.2007.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a series of male neonates with prenatally detected anterior urethral diverticula and discuss postnatal management. MATERIALS AND METHODS We retrospectively reviewed 3 cases of prenatally detected anterior urethral diverticula presenting between 1998 and 2005. RESULTS An anterior urethral cystic mass was identified prenatally in all 3 patients. One mass spontaneously ruptured prenatally. The patient underwent diverticulectomy and urethroplasty at age 6 months. Two patients had obstructive uropathy with oligohydramnios and were delivered at 32 weeks of gestation. Both cases were managed by urethrostomy and subsequent diverticulectomy and urethroplasty at age 6 months. CONCLUSIONS Infravesical obstruction from a urethral diverticulum can be accurately identified and differentiated from other causes prenatally. Marsupialization is an excellent option for temporary urinary diversion when the clinical situation precludes primary excision and repair.
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Affiliation(s)
- Douglas E Coplen
- Division of Pediatric Urology, St. Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
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30
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Abstract
Congenital anterior urethral diverticulum is an uncommon condition that tends to present in older children with signs of chronic urinary problems. A neonate presented following recurrent collapse, and cystography revealed a giant urethral diverticulum. The diverticulum was incised at cystoscopy, leading to a full recovery.
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Affiliation(s)
- Alan J Howieson
- Department of Paediatric Surgery, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK
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Kajiwara M, Inoue K, Kato M, Usui A, Matsubara A, Usui T. Anterior urethral valves in children: A possible association between anterior urethral valves and Cowper’s duct cyst. Int J Urol 2007; 14:156-60. [PMID: 17302575 DOI: 10.1111/j.1442-2042.2007.01617.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To elucidate the pathophysiology of congenital obstruction of the anterior urethra and to investigate the association between anterior urethral valves and syringocele. Three boys with congenital obstruction of the anterior urethra diagnosed at our department between 1997 and 2004 were analyzed retrospectively. All three boys had congenital obstruction in the bulbar urethra. The presenting symptoms and age of each patient were varied. Whereas continuity between Cowper's duct and the diverticulum was not demonstrated radiographically in all of the boys, it was speculated endoscopically in all. Our series has suggested a possible association between anterior urethral valves (diverticulum) and syringocele. These congenital anomalies of the anterior urethra should be considered in the differential diagnosis of obstructive lesions of the urinary tract.
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Affiliation(s)
- Mitsuru Kajiwara
- Department of Urology, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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Affiliation(s)
- Rubén A Quintero
- Florida Institute for Fetal Diagnosis and Therapy, Tampa, Florida 33613, USA.
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Kajbafzadeh AM, Jangouk P, Ahmadi Yazdi C. Anterior urethral valve associated with posterior urethral valves. J Pediatr Urol 2005; 1:433-5. [PMID: 18947585 DOI: 10.1016/j.jpurol.2005.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
The association of anterior urethral valve (AUV) with posterior urethral valve (PUV) is rare. A 7-month-old infant was presented at a district hospital with episodes of acute pyelonephritis. He was treated medically and a voiding cystourethrogram (VCUG) confirmed bilateral vesico-urethral reflux. The presence of concomitant AUV and PUV was not recognized. He underwent several surgical procedures, which failed. He had reflux recurrence following two antireflux procedures. He had urinary retention after each operation, which was managed by vesicostomy and perineal urethrostomy. At the age of 3.5 years, he was referred to our paediatric urology clinic. Noticing the AUV and PUV in the past VCUG, the valves were fulgurated. Urodynamic study before and 3 months after valve ablation showed a high voiding pressure. VCUG 6 months following ablation showed no reflux, but several uroflowmetric studies showed a staccato and interrupted pattern. Empirical treatment with an alpha-blocker was started. One year after treatment, a repeat VCUG showed no reflux. Uroflowmetry and urodynamic studies returned to normal. The perineal urethrostomy was closed. The child was asymptomatic after 9 months of follow up.
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Affiliation(s)
- A M Kajbafzadeh
- Department of Paediatric Urology, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Downsizing and refinement of the pediatric endoscope in video-monitoring systems have facilitated genitourinary endoscopy even in small children without any traumatic instrumentation. Indications for endoscopy in children with hematuria or tractable urinary tract infection have been tailored for the rareness of genitourinary malignancy or secondary vesicoureteral reflux (VUR) as a result of infravesical obstruction. Most mechanical outlet obstructions can be relieved endoscopically irrespective of sex and age. Endoscopic decompression by puncture or incision of both intravesical and ectopic ureteroceles can be an initial treatment similar to open surgery for an affected upper moiety. Endoscopy is necessary following urodynamic study to exclude minor infravesical obstruction only in children with unexplained dysfunctional voiding. Genitourinary endoscopy is helpful for structural abnormalities before and at the time of repairing congenital urogenital anomalies. Endoscopic injection therapy of VUR has been established as a less invasive surgical treatment. Pediatric endoscopy will play a greater role in the armamentarium for most pediatric urological diseases through the analysis of visual data and discussion on the indications for endoscopy throughout the world.
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Affiliation(s)
- Katsuya Nonomura
- Hokkaido University, Graduate School of Medicine and Department of Urology, Renal and Genitourinary Surgery, Sapporo, Japan.
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35
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Literature Watch. J Laparoendosc Adv Surg Tech A 2005. [DOI: 10.1089/lap.2005.15.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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