A Study of the Sequelae of Posterior Urethral Valves

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Abstract
The drainage procedures prior to valve ablation and the long-term sequelae in the upper urinary tract of 135 boys with posterior urethral valves are discussed. Cutaneous ureterostomy in infants, used previously, was replaced largely by lower tract drainage using stab cystotomy combined with irrigation. The former technique is reserved for patients who do not improve. Older patients require no preliminary drainage. Long-term sequelae were studied with respect to urinary control, the fate of ureteral reflux and the state of upper tract dilatation. Of the patients, 14% remain incontinent owing to too radical a transurethral resection, bladder neck surgery or a gross degree of urethral dilatation found in neonates. Of the renal units, 32% were presented with ureteral reflux. After valve ablation moderate or gross reflux ceased spontaneously in 29% of the patients, it persisted in 35% and required antireflux surgery or nephrectomy in 36%. The upper urinary tracts were dilated in 90% of the renal units and most had moderate or gross dilatation, especially in infants. Of 116 units with moderate or gross dilatation or nonfunction, 65% remained unchanged after valve ablation, but 35% improved to normal or nearly normal. In 35 units with persistent dilatation in nonrefluxing systems the dilatation was associated with pelvioureteral or vesicoureteral obstruction in 10 units, although in 25 patients no obstruction could be identified. The dilatation was considered a manifestation of developmental dysplasia of the ureters.