Late diagnosis of posterior urethral valves: a case report and the literature review

Szawłoga Tomasz, Sobieszczańska-Droździel Aleksandra. Late diagnosis of posterior urethral valves: a case report and the literature review. Journal of Education, Health and Sport. 2022;12(2):122-130. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2022.12.02.014

https://apcz.umk.pl/JEHS/article/view/JEHS.2022.12.02.014

https://zenodo.org/record/6026049

The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343.

Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences).

Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159.

Przypisane dyscypliny naukowe:Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu).

© The Authors 2022;

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Received: 26.01.2022. Revised: 26.01.2022. Accepted: 09.02.2022.

Late diagnosis of posterior urethral valves: a case report and the literature review

Tomasz Szawłoga¹, Aleksandra Sobieszczańska-Droździel²

¹Student’s Scientific Group at the Department of Pediatric Nephrology, Medical University of Lublin, Poland

²Department of Pediatric Nephrology, Medical University of Lublin, Poland

Aleksandra Sobieszczańska-Droździel https://orcid.org/0000-0003-2702-5083 , aleksandra.sobieszczanska-drozdziel@umlub.pl

Tomasz Szawłoga https://orcid.org/0000-0002-4025-9813 tomasz.w.szawloga@gmail.com 

Abstract

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in boys. They are usually suspected antenatally or soon after the birth as the cause of severe hydronephrosis, oligohydramnios, renal hypodysplasia, and kidney failure. In milder forms of PUV, the uncharacteristic symptoms occur later in childhood, adolescence, or even adulthood and cause diagnostic problems. The final diagnosis and causative treatment of PUV are possible due to cystourethroscopy. Nevertheless, as a consequence of the defect, valve bladder syndrome (VBS) occurs and requires long-term treatment.

The authors present a case of a 14-year-old boy with a late diagnosis of PUV at the age of 7. Recurrent pyelonephritis and nonspecific voiding dysfunction were the first symptoms. Ultrasounds(US) were initially normal while videocystometry(VCM) showed the 3^rd-grade right-sided vesicoureteral reflux (VUR), bladder diverticulum as well as discrete detrusor overactivity, and reduced bladder capacity without any signs of bladder obstruction. Bilateral post-inflammatory nephropathy completed the clinical picture. In urethrocystoscopy surprisingly PUV were found and incised. Due to recurrent urinary tract infections (UTIs) one year later the STING procedure was performed which resulted in the resolution of VUR. Despite this, the features of bladder dysfunction, requiring regular urodynamic evaluation and pharmacotherapy, persisted.

Recurrent UTIs in boys may suggest urinary tract obstruction and PUV should be considered regardless of the patient's age. Early diagnosis and appropriate management may improve the prognosis.

Key words: posterior urethral valves, vesicoureteral reflux, urinary tract infections