Kifayat Khan, Ikram Udin, Muhammad Younus Khan.
Management ofinfants and children withposterior urethral valves: early outcome of endoscopic valve fulguration in a tertiary care hospital in Peshawar.
J Saidu Med Col Jan ;7(1):17-21.

BACKGROUND: Posterior urethral valve is a common cause of bladder outlet obstruction in new born babies. Antenatal diagnosis is established by ultrasonography. The management of posterior urethral valves starts from the intra uterine life. Number of procedures have been performed to relieve urinary obstruction after birth including catheter drainage, cutaneous vesicostomy, ureterostomy and urethral valves ablation. People had been performing balloon traction ( catheter Fogarty ), hook traction and tranperineal resection of valves. Endoscopic ablation of the urethral valves is the gold standard at present OBJECTIVE: To know the early outcome of endoscopic posterior valves fulguration in infants and children in a tertiary care hospital in Peshawar. MATERIAL AND METHODS: It was a retrospective, descriptive study which was conducted at the department of pediatric surgery Postgraduate Medical Institute Lady Reading Hospital Peshawar from January 2010 to December 2015. All stable patients with the diagnosis of posterior urethral valves were included in the study except the patients below the age of six months. After admission to the ward, ultrasound (US) abdomen, micturatingcysto-urethrogram (MCUG), blood urea, serum creatinine and serum electrolytes were done in all patients apart from the routine investigations such as blood complete, HBS, HCV and urine analysis. Endoscopic valve fulguration was performed in all diagnosed patients using ball electrode and an adequate size cystoscope. The procedure was performed under general anesthesia and the urinary bladder was drained with a suitable size Foley's or silicon catheter for 2-3 days along with parenteral antibiotics. Patients were discharged from the hospital 48-72 hours after the procedure on oral antibiotics and were advised to come to the outpatient department for follow up visits for a period of 6 months. RESULTS: A total of 75 patients were included in the study. All were males with a mean age of 2 years ranging from 6 months to 7 years. Sixty patients were without any diversion while 15 had vesicostomy or ureterostomy already done in our department or somewhere else. Stricture urethra was seen in 5 patients, dribbling of urine in 20 patients, nocturnal enuresis in 15 patients, recurrent UTI in 60 patients and redo valve fulguration was done in 15 patients. Fifteen patients lost to follow up. CONCLUSION: Urethral valve ablation is the definitive treatment of posterior urethral valves. Endoscopic urethral valve fulguration is safe, effective and definitive way of management for posterior urethral valves. Early treatment improves the quality of life and prevents the ongoing renal damage. Early presentation in fetal and neonatal life has worst prognosis due to associated renal dysplasia. Key Words: obstructive uropathy, posterior urethral valves, endoscopic urethral valve fulguration, posterior urethral valve ablation.

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