Challenges in the management of posterior urethral valves in children in a teaching hospital in Nigeria

Abstract

Introduction: Posterior Urethral valve (PUV) is the commonest cause of congenital lower urinary tract obstruction in males. There has been significant improvement in outcome of patients with PUV in developed settings, however in resource limited settings like ours, it's management is still fraught with a lot of challenges with resultant poor outcome

Aim: To highlight the challenges in management and outcome of patients presenting with posterior urethral valves at the University of Port Harcourt Teaching Hospital over a 3year period.

Methods: This was a retrospective review of the folders of patients with posterior urethral valve to determine the prevalence, challenges and clinical outcome of such children in the renal unit of the University of Port Harcourt Teaching Hospital (UPTH) from June 2019 to April 2022.

Results: A total of 169 renal cases were seen over the study period with 20(12%) diagnosed with PUV. The age range was 1day to 12years with a mean age of 2.17 ± 2.95 yrs. Prenatal diagnosis was made in only 2(10%) patients and most presented after the neonatal period. The common complications were urinary tract infection in 16(80%) and Chronic kidney disease (CKD) in 10(50%) with mean initial serum creatinine at presentation of 277.35± 194.17umol/l. Urethral catheterization was done for all our patients to improve renal function and allow optimization prior to surgery. Four (20%) patients had transvesical excision of valves after one year of life and 1(5%) had vesicostomy. None had transurethral endoscopic valve resection. Seven patients (35%) had end stage kidney disease (ESKD) and mortality rate was 25%

Conclusion: The management of PUV in our environment is quite challenging with poor outcome.