Posterior urethral valves: management in resource limited economies

Abstract

Background: Posterior urethral valves (PUV) are congenital anomalies in males that cause significant morbidity and mortality.
Aim: To highlight the current trend in the management of boys with posterior urethral valves with attention to challenges in developing countries.
Methods: The literature on PUV was searched using Pub Med / Medline and AJOL. Relevant publications on embr yolog y, genetics, pathology, management, outcomes of PUV including contributions from developing countries were reviewed.
Results: PUV, increasingly diagnosed prenatally, presents a spectrum of severity. The concept of a true bicuspid valve has been substituted with a single diaphragm. The term congenital obstructing posterior urethral membrane has been advocated. The resulting varied severity and degree of obstruction depend on the configuration of the obstructive membrane. Treatment option depends on age at presentation, severity of symptoms and available resources. Prenatal intervention is dependent on gestational age, amniotic volume and renal function from foetal urine aspiration. Identification of patients who may benefit from early intervention remains inconclusive. There remains no clinical consensus about the efficacy and use of prenatal intervention. Endoscopic ablation of the valve is the gold standard of treatment. Use of Mohan's valvotome and other modalities are invaluable in developing countries where endoscopic facilities are limited.
Conclusions: The state of the bladder at diagnosis may determine the extent of recovery of renal function. Pre-natal imaging has improved the detection rates of PUV. Early valve ablation may best achieve renal functional recovery. The sophistification and outcome of management are related to the level of technological advancement.

Key words: Posterior urethral valves; Management; Developing countries