الفهرس 
Embryology and AnatomyOnly 14 pages are availabe for public view
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Abstract
Posterior urethral valves (PUV) are the commonest cause of infravesical outflow obstruction in boys with an incidence of 1:4000 - 1:7500 births.
Embryologically posterior urethral valves are congenital mucosal folds on either side of prostatic urethra. It was first described by Hugh Hamptos Young about 90 years ago.
Presentation of PUV ranges from none to very severe urinary tract obstruction to an extent that may not be compatible with postnatal life. In utero obstruction may results in hypoplastic kidneys, bilateral hydronephrosis, hydroureter, thickened hypertrophied or dilated urinary bladder. At birth patient may present with palpable kidney, retention of urine or renal failure. Older children usually present with UTI (Urinary tract infection), poor urinary stream, dribbling, straining to urinate, diurnal and nocturnal enuresis and palpable urinary bladder and kidneys.
Micturating csto-urethrogram (MCUG) confirms PUV and also determines vesico-ureteric reflux (VUR). Cystoscopy serves both diagnostic and therapeutic purposes.
Primary valve ablation is considered to be the treatment of choice for PUV. Temporary vesicostomy may be needed in some patients as urethra may be too small for available cystoscope. Refinements in instrumentation have made it possible to do per urethral fulguration of valves even in neonates. Patients who fail to respond to per urethral catheter drainage, associated massive VUR, massive urinary leakage may require vesical or supravesical diversion.
Although, reports are available suggesting no adverse effect of diversion, a non-compliant bladder as a result of diversion has been noted by others. Length of diversion and vesical infection causing fibrosis decreases the compliance of the bladder. The degree of bladder dysfunction is probably related to structural changes in the bladder wall. Glassberg reviewed the literature over the last 20 years with respect to outcome studies, histological findings, animal model experimentation and urodynamic investigations in boys with PUV. He described a varying degree of loss of compliance in the majority of patients. There was no evidence to suggest that the loss of compliance was secondary to diversion, as it was seen with all modes of treatment.
The study aimed to determine whether there is a significant lower urinary tract functional and structural difference between posterior urethral valve cases treated by primary valve fulgration and those treated by primary vesicostomy?
Thirty patients were enrolled in the study. Fifteen with primary valve fulgration and fifteen with vesicostomy and delayed fulgration. Patients were assessed by serum creatinine, MCUG, ultrasonography and urodymanic studies.
No statistical significant difference was found between 2 groups as regard clinical outcome, serum creatinine, GFR and urodynamic evaluation. There were statistically significant higher UTI attacks in vesicostomy group. VUR tended to resolve more in patients with vesicostomy group.
In conclusion, although primary fulgration is considered by most authors the gold standard of treatment of PUV, vesicostomy still play a very beneficial role in treating critically ill and low birth weight boys especially in developing countries where up to date instruments are not available.
Vesicostomies allowed babies to grow safely and protected upper urinary tracts from back pressure without negatively affecting bladder functions.