Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa

Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa

Abstract Objective To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. Methods A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demogr...

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Bibliographic Details
Published in:Journal of pediatric urology Vol. 10; no. 1; pp. 62 - 66
Main Authors: Lukong, C.S, Ameh, E.A, Mshelbwala, P.M, Jabo, B.A, Gomna, A, Anumah, M.A, Nmadu, P.T, Mfuh, A.Y
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01-02-2014
Subjects:
Bladder outflow
Child
Child, Preschool
Cystostomy
Dilatation, Pathologic
Humans
Infant
Infant, Newborn
Male
Nigeria
Obstruction
Pediatrics
Posterior urethral valve
Urethra - abnormalities
Urethra - pathology
Urethral Obstruction - surgery
Urinary Diversion - methods
Urology
Vesicostomy
Nigeria
Bladder outflow
Posterior urethral valve
Obstruction
Vesicostomy
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Summary:Abstract Objective To review the role of vesicostomy in the management of posterior urethral valve (PUV), in neonates and infants, given the limitations for endoscopic treatment in this setting. Methods A review of 35 patients who presented with posterior urethral valve over a 10-year period. Demographic and clinical information were prospectively recorded on a structured pro forma, and the data extracted analysed using SPSS 11.0. Results The 35 boys were aged 3 days to 10 years (median 3 weeks). Twenty-three (65.7%) had a vesicostomy (age range 3 days–3 years, median 3 weeks). The mode of presentation was poor urinary stream 15 (65.2%), urinary retention 4 (17.4%), and renal failure 6 (26.1%). Main findings were palpable bladder 23 (100%), hydronephrosis 4 (17.4%). Abdominal ultrasound confirmed hydronephrosis and thickened bladder wall, and voiding/expressive cystourethrogram confirmed dilated posterior urethra and vesicoureteric reflux in all 23 patients. Complications following vesicostomy were stoma stenosis 1 (4.3%), bladder mucosal prolapse 1 (4.3%), perivesicostomy abscess 1 (4.3%); there was no mortality. Following vesicostomy, 10 (43.5%) patients had excision of the valves and vesicostomy closure at age 2–8 years (median 4 years). They are well, with normal renal ultrasonographic findings, bladder capacity range 115–280 ml, and normal urea, serum electrolytes, creatinine, at 3 years of follow up. Thirteen (56.5%) are still awaiting valvotomy but have remained well and with normal ultrasonographic renal findings. Conclusion Vesicostomy is a useful temporising mode of urinary diversion in neonates and infants with posterior urethral valve (in the absence of unobstructed upper tracts) when facilities for endoscopic valve ablation are not readily available.
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ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2013.06.004