Posterior urethral valves in children: A review of 28 cases in Yaounde, Cameroon

Abstract

We reviewed the files of 28 children treated or followed up for posterior urethral valves (PUV) from 1^st January 1985 to the 31st of December 1996 in the University Teaching Hospital, Central Hospital and the General Hospital in Yaounde. Our objectives were to review the epidemiological aspects of PUV in Yaounde, assess the clinical presentation, diagnostic procedures and outcome following surgery in terms of renal function and patient growth. The mean age at diagnosis was 2.9 years (range 9days-13 years), mean age at first consultation after onset of symptoms 1.6 years (range 1 day-8 years) and the mean interval between age of first consultation and age at diagnosis was 9.7 months. The most frequent urinary symptoms were dribbling (60.7%) and dysuria (54%), whereas frequent non-urinary symptoms were fever (25%) and failure to thrive (25%). Diagnosis was confirmed on ultrasound in 3 patients and in the remaining 25 both ultrasound and voiding cystourethrograms made the confirmation.There was an overall improvement at follow-up in the glomerular filtration rates (GFR) in 67% of the patients although absolute values remained low in all but 1 patient. Growth was also improved in 56% of the patients. Concerning treatment, 26 patients underwent surgery and 2 were lost to follow-up after diagnosis. 20 patients underwent endoscopic valve ablations, 4 Blocksom vesicostomies, 3 cystostomies and 2 catheter ablations. At final evaluation, we noted 6 deaths (21%), 10 lost to follow-up (36%). Causes of the deaths were septicemia: 3 cases (50%); post-obstructive diuresis: 2 cases (33%) and chronic renal failure: 1 case (17%). We thus conclude that, efforts should be made by clinicians especially (obstetricians, surgeons, radiologists, and pediatricians) to make early diagnosis and management of PUV so that renal impairment should be avoided and optimal growth ensured.

Clinics in Mother and Child Health Vol. 1(2) 2004: 89-96