Psterior urethral valves (PUV) in neonates: which treatment should be applied in Africa? Experience of the university Hospital, Treichville

Abstract

Objective: African studies on posterior urethral valves (PUV) are rare. Early diagnosis and treatment of this pathology in sub-Saharan Africa are difficult. This study was carried out to describe – based on our experience – the diagnostic and therapeutic problems of PUV in Africa and to determine an adequate management in the neonate. Patients and Methods: This is a retrospective study based on 25 files of neonates treated at the Department of Pediatric Surgery, University Hospital of Treichville, Abidjan, Ivory Coast, between 1987 and 2002. The children's age ranged from 1 to 27 days. They were admitted for pre-natally diagnosed PUV in 2, post-natally diagnosed PUV in 2, acute urinary retention in 6, dysuria in 12, hematuria in 2 and abdominal mass in 1 patient. Treatment consisted of suprapubic catheterization (Cystocath®) in 4, vesicostomy in 11 and endoscopic resection in 10 cases. Results: Of the 4 patients treated with suprapubic catheterization, 2 were lost to follow up and 2 died. Vesicostomy showed a favorable outcome in 9 patients, while 2 patients died. Nine of the 10 patients treated by endoscopic resection showed a satisfactory outcome; the remaining patient died. The 9 patients that had survived vesicostomy were then subjected to endoscopic resection of the PUV. Mean follow up was 17 months (range 6 months – 3 years). After resection of the valves two of the 18 children that had survived were lost to follow up, while the 16 remaining ones were followed up for more than one year. Conclusion: In our environment, mortality associated with complications of posterior urethral valves is still high. It could be reduced by early diagnosis and endoscopic resection of the valves in the neonate. Urinary diversion may be a life-saving procedure in severe cases. Antenatal surgery is not yet applicable in our working environment. On the other hand, it is not likely to improve renal function. The renal function has to be regularly checked until adulthood to avoid renal insufficiency.

African Journal of Urology Vol. 12 (4) 2006: pp. 193-199