Posterior urethral valve in childhood in Port Harcourt, Nigeria

Abstract

Background: Posterior urethral valve (PUV) accounts for 20-40% of end stage renal diseases in children. In developed countries, prenatal  diagnosis and early surgery has improved the outcome.
Aim: To determine the prevalence, morbidity and mortality in children with PUV seen over a 2-year period in University of Port-Harcourt Teaching Hospital.
Methods: All children seen in the paediatric units of the Hospital with diagnosis of posterior urethral valves were recruited to determine the clinical presentation, treatment and outcome.
Results: Out of 36,700 paediatric patients seen, 15 (0.04%) had diagnosis of PUV, giving an incidence of 1: 2447. The age range was 3days to 15 years (mean of 22.8±19.4months). Three (20%) patients had valve ablation before the study. Symptoms started in the first week of life in 11 (73.3%) patients of which 4 (36.4%) presented in the neonatal period and 12 (80%) presented in infancy. The commonest symptom was dribbling of urine in all patients. The commonest complications were urinary tract infection [10 (66.7%)], acute renal failure [7 (46.7%)] and end stage renal disease [2 (13.3%)].  Prenatal diagnosis was made in only one patient. Abdominal ultrasound at diagnosis revealed lower obstructive uropathy in 13 (86.7%). Micturating cystourethrogram showed dilated posterior urethra and bladder wall thickness in 8 (53.3%). None had vesicoureteric reflux.  Hospital mortality rate was 20.0% and 5 (33.3%) were lost to follow up.
Conclusion: PUV is a significant cause of end stage renal disease and mortality with delayed presentation in our environment. Early diagnosis and surgery with prolonged follow up of all patients by nephrologists is advocated.

Keywords: Posterior urethral valve, Childhood, Port Harcourt, Outcome