Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review.

The management of 108 patients with posterior urethral valves from 7 pediatric surgical centers has been reviewed. All the patients have been treated in the 10 year period since 1970. 53 were under 3 mo of age at presentation (Group I), 8 between 3 mo and 1 yr (Group II), 22 between 1 and 5 yr (Group III), and 25 over 5 yr of age (Group IV). Under 5 yr of age urinary infection (37) and renal failure (22) were the commonest methods of presentation. Over 5 yr of age diurnal and nocturnal enuresis were the commonest symptoms. Endoscopic fulguration of the valves with or without preliminary catheter drainage has been the treatment of choice. Repeated fulguration of residual valve cusps was often required. The incidence of urethral stricture (2 patients) was highest after the use of the resectoscope. Refashioning and reimplantation of the ureters is associated with a high complication rate and is not recommended. Secondary operations on the bladder neck have been avoided in this series due to the risk of incontinence. 8 patients died (7.4%) and 7 of these deaths occurred in patients presenting under 3 mo of age. One patient died from renal failure 7 yr after the diagnosis of posterior urethral valves at 2 yr of age. It is suggested that the high mortality from renal failure in the group presenting early is related to renal dysplasia.