1
|
Mo Z, Zhang W, Sun N, Tian J, Li M, Song H, Xie X. Assessment of clinical prognosis improvement in children with concomitant anterior and posterior urethral valves: A case series report. Medicine (Baltimore) 2024; 103:e37004. [PMID: 38277528 PMCID: PMC10817129 DOI: 10.1097/md.0000000000037004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/29/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Concomitant anterior urethral valves (AUVs) and posterior urethral valves (PUVs) is an extremely rare congenital urologic anomaly, which may be easily overlooked in the clinic. OBJECTIVE This study assessed the prognosis of children with concomitant PUVs and AUVs. METHODS The clinical data of inpatients with concomitant AUVs and PUVs in our hospital were collected from January 1983 to June 2022. The clinical manifestations, auxiliary inspection, and treatment were described in detail. RESULTS In total, 6 cases of concomitant AUVs and PUVs in boys were found in our hospital, with ages ranging from 3 months to 9 years; the main clinical manifestation was abnormal urination. Four patients exhibited concomitant AUVs and PUVs preoperatively and underwent simultaneous anterior and posterior urethral valvotomy. Follow-up studies showed that 3 patients' clinical symptoms substantially improved with well-maintained renal function. One patient died of renal failure. In the other 2 patients, PUVs were initially identified and excised, but their clinical symptoms did not show substantial improvement. Following voiding cystourethrography (VCUG), the AUVs were found and obstructions were then completely relieved. However, 2 patients died of renal failure. CONCLUSIONS If urinary symptoms cannot be substantially relieved after posterior urethral valvotomy, VCUG and cystoscopy should be repeated to shorten the interval between anterior and posterior urethral valvotomies to improve patient prognosis.
Collapse
Affiliation(s)
- Zhiqiang Mo
- Urology Department, Shunyi Maternal and Children’s Hospital of Beijing Children’s Hospital, Beijing, China
- Pediatric Medical School, Capital Medical University, Beijing, China
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Weiping Zhang
- Pediatric Medical School, Capital Medical University, Beijing, China
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ning Sun
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jun Tian
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Minglei Li
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Hongcheng Song
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xianghui Xie
- Urology Department, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| |
Collapse
|
2
|
Menon P, Rao KLN. Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves. J Pediatr Urol 2022; 18:663.e1-663.e9. [PMID: 36123286 DOI: 10.1016/j.jpurol.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/21/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002-2020. MATERIAL AND METHODS Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed. RESULTS There were 27 patients [AUV (n = 11); AUD (n = 16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days-12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n = 3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig. 1B, C). Urethral hypoplasia distal to the valve (n = 4) urethral duplication (n = 1) were associated (Fig. 1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1 mg/dL (n = 5), trabeculated bladder (n = 12), and vesicoureteral reflux (VUR) (n = 12) was noted at presentation. Diverticulum/valve excision (n = 13, 48.2%), fulguration alone (n = 12, 44.4%) and primary urinary diversion (n = 2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n = 6), VUR (n = 4), impaired renal function on scans (n = 8), and lower urinary tract dysfunction (n = 7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1 mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60 ml/kg/min. CONCLUSIONS Co-existing PUV and AUD present earlier and have specific imaging findings. In proximal AUD, possibility of syringocele should be kept in mind, as they have similar presentation and imaging. Concomitant PUV did not alter prognosis. Secondary effects on bladder and renal function were more with AUD. Follow up eGFR less than 60 ml/kg/min was associated with pre-operative elevated serum creatinine, trabeculated bladder, non-dilated posterior urethra, and bilateral impaired renal function on scans.
Collapse
Affiliation(s)
- P Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - K L N Rao
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
3
|
Ekberli G, Taner S, Şener NC. Rare presentation of voiding difficulty in an adolescent: Answers. Pediatr Nephrol 2022; 37:1303-1305. [PMID: 35006352 DOI: 10.1007/s00467-021-05409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Gunay Ekberli
- Ministry of Health, Adana City Training and Research Hospital, Yuregir, Adana, Turkey.
| | - Sevgin Taner
- Ministry of Health, Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Nevzat Can Şener
- Ministry of Health, Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Naini AR, Kapkanova N, Zelesco M. Fetal urinary ascites and spontaneous bladder rupture—A rare case of anterior urethral valves: A case report. SONOGRAPHY 2021. [DOI: 10.1002/sono.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anitha Reddy Naini
- Department of Medical Imaging Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Natasha Kapkanova
- Department of Medical Imaging Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Marilyn Zelesco
- Department of Medical Imaging Fiona Stanley Hospital Murdoch Western Australia Australia
| |
Collapse
|
6
|
Cini C, Mantovani A, Cianci MC, Landi L, Bortot G, Sforza S, Taverna M, Elia A, Masieri L. Check cystoscopy in the management of anterior urethral valves in a cohort of pediatric patients. J Pediatr Urol 2021; 17:231.e1-231.e7. [PMID: 33648856 DOI: 10.1016/j.jpurol.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient's age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available. OBJECTIVE We describe our protocol for AUV treatment based on primary endoscopic valve ablation followed by check cystoscopy 15 days later. STUDY DESIGN Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and VCUG were performed in all children, while urodynamic evaluation was performed in the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves ablation and after 15 days after a second look cystoscopy was performed. Follow up was based on clinical and radiological evaluation with US, urinalysis and blood tests. Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained patients and VCUG was performed in 1/5 patient. RESULTS and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra in another case. In 3/5 patients check cystoscopy found residual valves and a second endoscopic ablation was performed. All patients achieved symptoms release and improved urodynamic parameters. No intra or post-operative complication were reported. The assessment of residual valves is variable in literature and it is usually described for posterior urethral valves (PUVs). Few series report the use of VCUG within the first week after valve ablation, our experience instead suggests that performing a second look cystoscopy, is very effective to evaluate the presence of residual AUVs and eventually proceed with further ablation. CONCLUSION Endoscopic ablation is the gold standard treatment for AUV, but residual valves management is not clearly defined. According to our experience, a check cystoscopy 15 days after primary ablation allows to identify and treat possible residual valves showing good results in terms of safety and efficacy.
Collapse
Affiliation(s)
- Chiara Cini
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Alberto Mantovani
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy.
| | - Maria Chiara Cianci
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Luca Landi
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Giulia Bortot
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Simone Sforza
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Maria Taverna
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Antonio Elia
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| | - Lorenzo Masieri
- Pediatric Urology Department Meyer Children Hospital, viale Pieraccini 24, Firenze, 50139, Italy
| |
Collapse
|
7
|
Jain P, Prasad A, Jain S. Are anterior urethral valve and anterior urethral diverticulum two separate entities: A radiological and endoscopic review. J Pediatr Urol 2021; 17:101.e1-101.e9. [PMID: 33229229 DOI: 10.1016/j.jpurol.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anterior urethral valve (AUV) and anterior urethral diverticulum (AUD) are two rare causes of anterior urethral obstruction with variable presentation and anatomy. Their existence as the same or different entity is still debatable, and management has not yet been standardized. OBJECTIVE This study is a retrospective review of cases diagnosed with anterior urethral obstruction and correlation of radiological and endoscopic anatomy of AUV and AUD. STUDY DESIGN A retrospective review of cases diagnosed with AUV and AUD, between May 2013 and February 2020 is presented. The presentation, laboratory, radiological and endoscopic anatomy along with the management required was reviewed. A special emphasis has been given on the correlation of radiological and endoscopic anatomy and an attempt has been made to standardize the management. RESULTS A total of 8 patients with age ranging from 2 months to 9 years were reviewed. Poor urinary stream and recurrent UTI was the commonest presentation. The anatomy of the anterior urethra on VCUG (voiding cystourethrogram) and Urethrocystoscopy was correlated. Two sets of patients were identified. In the first set, five cases on endoscopy had findings of the classical valve-like fold in the anterior urethra with immediate proximal dilation of the urethra giving the appearance of a 'pseudodiverticula' without any definite opening. In three of these cases, endoscopic findings correlated well with radiological findings of 'pseudodiverticula' in which dilated proximal urethra formed an obtuse angle with the ventral floor of the urethra. The other set of four patients had a 'true diverticula' on endoscopy with a well-defined mouth and prominent distal lip, correlating well with radiological findings of a 'true diverticula' forming an acute angle with the ventral floor of the urethra. One case on endoscopy had both an anterior urethral valve with a proximal 'pseudodiverticula and a large wide-mouthed bulbar 'true diverticula'. All the patients with classical valves were successfully treated using a resectoscope while two patients with 'true diverticula' were successfully managed by incising the distal lip. One of the patients previously managed for the posterior urethral valve (PUV) had both classical valves in the anterior urethra with proximal 'pseudodiverticula' and a bulbar 'true diverticula'. The AUV was ablated with a resectoscope while 'true diverticula' required diverticulectomy. All the patients after follow up of 3 months-8 years, were asymptomatic except the one with 'true diverticulum' who remained symptomatic after TUR (Trans-urethral resection) and required vesicostomy. DISCUSSION AUV and AUD both can cause obstructive uropathy. The proximal dilatation related to AUV cannot be labeled as a 'true diverticula', which lacks a classical orifice. The distal obstructing lip of 'true diverticula' should not be confused with a classical mucosal valve-like fold seen in AUV. While AUV and small AUD can be treated with endoscopic ablation, large diverticula as a result of wide spongiosal defects require surgical excision. A good understanding of their radiological and endoscopic anatomy is required to differentiate them and decide for appropriate management. CONCLUSION Based on our experience, AUV and AUD should be differentiated and should be considered as two separate entities.
Collapse
Affiliation(s)
- Prashant Jain
- Department of Paediatric Surgery and Paediatric Urology, BLK Centre for Child Health, BLK Super Speciality Hospital, New Delhi, India.
| | - Ashish Prasad
- Department of Paediatric Surgery and Paediatric Urology, BLK Centre for Child Health, BLK Super Speciality Hospital, New Delhi, India
| | - Sarika Jain
- Department of Radiodiagnosis, DODA Imaging, PUSA Road, New Delhi, India
| |
Collapse
|
8
|
Shields LBE, White JT, Mohamed AZ, Peppas DS, Rosenberg E. Delayed Presentation of Urethral Valves: A Diagnosis That Should Be Suspected Despite a Normal Prenatal Ultrasound. Glob Pediatr Health 2020; 7:2333794X20958918. [PMID: 33117862 PMCID: PMC7570289 DOI: 10.1177/2333794x20958918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background. Congenital urethral obstruction occurs most frequently as a result of urethral valves. The diagnosis is usually confirmed pre- or neonatally. Though not ideal, delayed diagnosis can occur in childhood, adolescence, or adulthood. Despite a normal prenatal ultrasound, there may still be a delayed diagnosis of urethral valves. Methods. We present 4 patients with delayed diagnosis of posterior urethral valves (PUV) and 1 patient with delayed diagnosis of anterior urethral valves (AUV) who were evaluated by a pediatric urologist at our Institution. We determined the age and symptoms at presentation, physical examination, micturating cystourethrogram (MCU) findings prior to the valve ablation, renal function before and after valve ablation, type of valve ablation, and urine culture and sensitivity. The urological courses following urethral valve ablation including urodynamic study findings are described. Results. The median age at presentation was 33 months. All 5 patients presented with decreased urine output and urinary retention. All 5 patients underwent a MCU that demonstrated bladder trabeculations (3 cases), vesicoureteral reflux (3 cases), and bladder diverticula (2 cases). A urethral valve ablation was performed in all cases. Four patients underwent a renal function panel prior to this procedure, and their serum BUN/creatinine levels decreased 1 day postoperatively. Conclusion. Pediatricians should consider urethral valves as causing urethral obstruction although the prenatal ultrasound may be normal. Early diagnosis and prompt treatment of urethral valves may mitigate the potentially devastating morbidities such as renal failure, congestive heart failure, and respiratory distress that may ensue.
Collapse
Affiliation(s)
| | | | - Ahmad Z Mohamed
- University of Louisville School of Medicine, Louisville, KY, USA
| | | | | |
Collapse
|
9
|
Anterior urethral valves - A rare but challenging congenital pathology. J Pediatr Urol 2020; 16:585.e1-585.e7. [PMID: 32340880 DOI: 10.1016/j.jpurol.2020.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Anterior urethral valves (AUV) and associated anterior urethral diverticula (AUD) are a rare cause of congenital lower urinary tract obstruction. They occur 25-30 times less frequently than posterior urethral valves (PUV) and historically tend to have a less aggressive presentation and outcome. However, due to the low incidence, little is known about management and long-term prognosis. OBJECTIVE We aim to evaluate the outcomes after AUV valve ablation and compare this group to a previously studied PUV cohort. STUDY DESIGN In this IRB-approved study, we retrospectively identified all patients from 2002 to 2017 undergoing valve ablation using CPT code 52400. Charts were manually reviewed to identify AUV patients, their presenting symptoms, timing of diagnosis, pre and postnatal imaging findings, age at presentation and valve ablation, creatinine, recurrences, additional surgeries and follow-up. The AUV group was then compared to a previously studied PUV cohort of 104 patients from our institution. RESULTS Nine AUV patients were identified. Only four (44%) patients were diagnosed prenatally. Three (33%) patients were diagnosed neonatally, one for weak stream/dribbling and two for febrile UTIs. The remaining two patients were diagnosed at ages 3 and 4 due to dysuria and penile swelling with micturition. Patients presenting later in life had no evidence of renal dysfunction or VUR. All patients underwent primary TUR-AUV (1 laser, 4 cold knife, 4 cautery), but 55% had residual valves and/or diverticula identified on routine postoperative imaging in two patients and due to development of clinic symptoms in three patients. All five patients with recurrences underwent repeat endoscopic evaluation, and thereafter two patients required urethral reconstruction. In contrast, only 15% (16/104) of PUV patients required re-TUR (p = 0.01). At an average follow-up time of 4.24 years (range 0.6-11.4 years), 44% of patients had no evidence of CKD, and two patients (22%) had progressed to CKD of at least stage IIIA, compared to 21.4% in the PUV cohort at a mean follow-up of 2.3 years. DISCUSSION The overall incidence of AUV is low, making it difficult to characterize these patients definitively. However, despite a milder phenotype and later presentation in most AUV patients, they do require more aggressive surgical treatment for complete resolution of the AUV. Furthermore, the long-term renal outcomes appear more severe than previously reported. CONCLUSIONS The poorer outcomes of AUV patients both with respect to recurrence and long-term CKD indicate that close urologic follow-up is essential in this group.
Collapse
|
10
|
Perlman S, Borovitz Y, Ben-Meir D, Hazan Y, Nagar R, Bardin R, Brusilov M, Dekel B, Achiron R, Gilboa Y. Prenatal diagnosis and postnatal outcome of anterior urethral anomalies. Prenat Diagn 2019; 40:191-196. [PMID: 31654578 DOI: 10.1002/pd.5582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/24/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Anterior urethral anomalies (AUA) which present as anterior urethral valve, stenosis or atresia, are a rare cause for congenital urinary tract obstruction. We present our AUA prenatal diagnosis case series. METHODS Fetuses presenting with prenatal findings suggestive for AUA according to postnatal reported clinical and imaging signs (urinary tract dilatation, dilated bladder, enlarged edematous fetal penis, dilatation of the fetal urethra and diverticula) were followed prospectively. RESULTS Six fetuses were diagnosed with AUA. Diagnosis was confirmed upon examination of the neonate or the abortus. All cases presented with variable degrees of urinary tract dilatation. Four fetuses who presented with additional congenital anomalies of the kidneys and urinary tract (CAKUT) developed intra-uterine or early postnatal renal failure, while two isolated AUA cases have a normal renal outcome. CONCLUSIONS AUA is a rare diagnosis. However, high index of suspicion and careful sonographic assessment of the male fetal urethra in cases referred for urinary tract dilatation may enable appropriate parent counseling, optimal prenatal surveillance and timed postnatal urological intervention. As in other lower urinary tract obstructions, future renal function seems to correlate with associated CAKUT, therefore close follow up throughout pregnancy and meticulous sonographic assessment is recommended.
Collapse
Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Borovitz
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Schneider Children's Medical Center, Nephrology Institute, Petach Tikva, Israel
| | - David Ben-Meir
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Pediatric Urology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Yenon Hazan
- Ultrasound Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.,Hadassah and the Hebrew University Medical School, Jerusalem, Israel
| | - Ran Nagar
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Bardin
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Michael Brusilov
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Ultrasound Unit, Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Benjamin Dekel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Pediatric Nephrology, Edmond and Lily Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Pediatric Stem Cell Research Institute, Edmond and Lily Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
11
|
Lynn AQ, Toce MS, Neal JT. Neonate With Abdominal Distention. Ann Emerg Med 2019; 73:e41-e42. [PMID: 30902180 DOI: 10.1016/j.annemergmed.2018.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Alex Q Lynn
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Michael S Toce
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Jeffrey T Neal
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| |
Collapse
|
12
|
Salem AB, Mazhoud I, Laamiri R, Salem R, Laajili H, Sahnoun L, Hafsa C. Anterior Urethral Valve: Uncommon Association with Renal Duplicity. J Neonatal Surg 2017; 6:41. [PMID: 28770138 PMCID: PMC5538606 DOI: 10.21699/jns.v6i2.544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/28/2017] [Indexed: 12/04/2022] Open
Abstract
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. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.
Collapse
|
13
|
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.
Collapse
|
14
|
Kajbafzadeh AM, Hosseini Sharifi SH, Keihani S, Soltani MH, Tajali A, Salavati A, Payabvash S, Mehdizadeh M. Concomitant anterior and posterior urethral valves in pediatrics: A single center experience over 12 years and long-term follow up after endoscopic treatment. Int J Urol 2015; 22:514-9. [DOI: 10.1111/iju.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/04/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Sorena Keihani
- Pediatric Center of Excellence; Tehran University of Medical Sciences; Tehran Iran
| | | | - Afshin Tajali
- Pediatric Center of Excellence; Tehran University of Medical Sciences; Tehran Iran
| | - Alborz Salavati
- Pediatric Center of Excellence; Tehran University of Medical Sciences; Tehran Iran
| | - Seyedmehdi Payabvash
- Department of Radiology; University of Minnesota Medical Center; Minneapolis Minnesota USA
| | - Mehrzad Mehdizadeh
- Department of Pediatric Radiology; Children's Hospital Medical Center; Pediatric Center of Excellence; Tehran University of Medical Sciences; Tehran Iran
| |
Collapse
|
15
|
Abstract
This article summarizes the most recent literature regarding congenital lower urinary tract obstruction in the fetus and newborn. Lower urinary tract obstruction is a heterogeneous group of rare diagnoses that have significant potential for in utero mortality and long-term morbidity in survivors. The diagnosis and management of the most common causes are reviewed. In addition, the current state of prenatal intervention for congenital lower urinary tract obstruction is discussed.
Collapse
Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA.
| | - John W Brock
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA
| |
Collapse
|