الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Posterior urethral valves (PUVs) are a common cause of lower urinary tract obstruction in male infants and the most common congenital cause of bilateral renal obstruction. The initial treatment of a newborn diagnosed with PUV should begin with bladder drainage by urethral catheter, antibiotic administration and correction of fluid and electrolyte abnormalities. Endoscopic valve ablation is the gold standard mode of treatment. The prognosis of these children is quite poor and one third of children develop renal failure by the age of adolescence. The valve-bladder syndrome is the worst end of PUV spectrum. It is defined as persistence or progression of hydronephrosis long after primary valve ablation. Bladder neck obstruction was thought to have a role in the development of VBS.
Our study was carried out on 20 patients. The study was conducted in the Department of Genitourinary surgery, Alexandria University Hospitals. Twenty patients with valve bladder syndrome were included in the study, their age ranged between 6 months to 3 years with a mean age of 16 months. Patients were randomized into 2 groups. Group I included 10 children with valve bladder syndrome who underwent diagnostic cystourethroscopy and follow up .Group II included 10 children who underwent cystourethroscopy and simultaneous injection of 100 I.U of Botox® in the bladder neck at 3, 6, 9 o`clock positions and follow up. All the patients were on anticholinergic therapy and clean intermittent catheterization.
The two groups were followed at 1, 3, 6 months by examination, serum creatinine, ultrasonography, VCUG, urodynamics and cystourethroscopy.
The results were tabulated and analysed. At the end of the study, we concluded that bladder neck obstruction cannot be demonstrated as an etiology of VBS, especially in those boys with myogenic failure and any attempt to abolish the effect of bladder neck by incision or Botox injection is prohibited. However, further studies are needed to have better management of VBS.