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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 182-183
 

A rare presentation of posterior urethral valves in adults


Kamats Kidney Hospital, Kothi, Baroda, India

Correspondence Address:
Nagesh Kamat
Kamats Kidney Hospital, Opposite Government Press, Kothi, Baroda - 390 001
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Posterior urethral valves, adults, stricture urethra.


How to cite this article:
Kamat N. A rare presentation of posterior urethral valves in adults. Indian J Urol 2004;20:182-3

How to cite this URL:
Kamat N. A rare presentation of posterior urethral valves in adults. Indian J Urol [serial online] 2004 [cited 2019 Jun 24];20:182-3. Available from: http://www.indianjurol.com/text.asp?2004/20/2/182/20760



   Case Report Top


A 20-year-old male presented with difficulty in passing urine. He was completely alright at the age of 9 when he had complaints of straining and dribbling. Since that age the patient had undergone urethral dilatation many times but the obstructive urinary complaints persisted. He was investigated and treated at various centres, but a micturat­ing cystourethrogram (MCUG) was never done as a cath­eter could not be negotiated beyond the strictured meatus. When the patient presented to us he was suffering from obstructive urinary problems for the past 11 years. Ex­amination of the penis revealed a' sclerosed and scarred external urethral meatus, and a chord like fibrosed urethra was palpable. Working on a provisional diagnosis of ure­thral stricture due to the evident local examination find­ings, a retrograde urethrogram [Figure - 1] was performed which showed a narrow, sclerosed, and nondistensible anterior urethra. To complete the study, a micturating ure­throgram was performed by instilling contrast into the blad­der with a suprapubic needle puncture. The findings came as a surprise as the MCUG [Figure - 2] showed a grossly di­lated posterior urethra suspicious of a missed posterior urethral valve (PUV). The bladder walls were uniform and regular and there was no reflux. Ultrasound confirmed the dilated posterior urethra but the kidneys and the ure­ters were undilated.

A diagnostic urethroscopy was impossible due to the sclerosed urethra. So a first stage of Johannsons type ure­throplasty with diagnostic urethroscopy through the peri­neal stoma, and fulguration of the posterior urethral valves was planned. The urethra was opened up to the proximal bulbar urethra. On urethroscopy from this level, the fleshy posterior urethral valves were visualised and resected with a Storz 26F resectoscope and a cutting loop. A horse­shoe flap was tunneled in to the posterior urethra to form the margins of the perineal urethrostomy. A diverting su­prapubic cystostomy was placed. Postoperative recovery was uneventful, and the patient passed urine with a good stream. The patient is planned for the second stage ure­throplasty after six months.


   Comments Top


Posterior urethrla valves presenting in adults have been described frequently in literature. [1],[2],[3] but this is the first case report where its presentation is superimposing that of an urethral stricture. The diagnosis of a posterior urethral valve was additionally suspected because the patient gave a history of the onset of the obstructive urinary complaints since his childhood. Despite the various urethral manipu­lations and dilatations, the patient never had a satisfactory stream, even immediately after the procedure. It is likely that the urethral stricture was iatrogenic. The strong sus­picion of a congenital cause compelled us to aggressively search for the posterior urethral valve, and we were re­warded with the findings on the MCUG. It is also possi­ble that the other clinicians were discouraged from performing the micturating urethrogram due the inability to pass the catheter perurethrally, due the dense stricturous urethra. The corrective surgery was planned in such a way that the stricture could be treated, and at the same time the PUV could be visualized and resected. The post­operative result was excellent, and the urine flow after the first stage urethroplasty and PUV resection was very good. A vigilant history elicitation, and aggressive MCUG picked up the hidden PUV.

 
   References Top

1.Bomalaski MD. Anema JG. Coplen DE. Koo HP, Rozanski T. Bloom DA. Delayed presentation of posterior urethrla valves: a not so be­nign condition. J Urol 1999; 162: 2130-2.  Back to cited text no. 1    
2.Heaton ND, Kadow C, Yates-bell AJ. Late presentation of congenital posterior urethral valves. Br J Urol 1989: 64: 98.  Back to cited text no. 2    
3.Opsomer RJ, Wese FX, Dardenne AN, Van Cangh PJ. Posterior urethral valves in adult males. Urology 1990: 36: 35-37.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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