الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Posterior urethral valves (PUV), particularly an important clinical disorder because severe urethral obstruction results in widespread damage and dysfunction of the entire urinary tract, affecting renal function, ureteral and bladder smooth muscle function, and urinary continence.
PUV remains the single most common urologic cause for renal failure and need for renal transplantation in children. Lower urinary tract obstruction in children is often silent or non-specific. A spectrum of signs and symptoms ranging from severe obstruction with resultant renal failure, urosepsis and pulmonary hypoplasia extending to mild trivial symptoms may be noted. The widespread use of prenatal ultrasound has now provided the opportunity to identify many patients with PUV before birth. Such diagnosis might allow earlier relief of obstruction and greater recovery or protection of renal function.
This prospective randomized study included 48 patients presented with posterior urethral valve (36 patients at Abo El-Reish University Hospital, Cairo University and 12 patients at Minia University Hospital). In the period between May 2010 to May2013.The age of presentation ranged from 9 days to 7 years (mean= 27 months, median=22 months).
The most common presentation of PUV was weak urinary stream and difficulty of micturation (in 38%) followed by urosepsis (in 25%). Initial examination showed that 76% of patients had weights ≤ 10th percentile for age and 81% had heights ≤ 10th percentile for age, and 66.6% had renal impairment. Bilateral massive HN was noted in 58.3% % of patients, thickened bladder wall in all, and VUR in 50%. VCUG was diagnostic for PUV in the majority of cases, while urethrocystoscopy was needed to establish the diagnosis in the rest.
Primary PUV ablation was done in 35 cases, while 13 cases underwent vesicostomy (due to either the absence of the small urethrocystoscope, or uncontrolled urosepsis). Post-vesicostomy valve ablation was done for all patients after a median time of 7 months, followed by closure of vesicostomy within one month. Valve ablation was done using hot knife in 28/48 patients, bugbee electrode in 12/48 patients and 8/48 using laser valve fulguration with presence of residual valve remnants in 7 patients and stricture urethra (at the ablation site) in 3 patients.