Endosurgical treatment of newborns and young children with posterior urethral valves

Sergey Zorkin; Aleksey Gusev; Aleksandra Gurskaya; Sergey Karpachev; Rimir Bayazitov; Ekaterina Ekimovskaya; Inna Karnuta; Dinara Akhmedova; Mariya Sulavko; Antonina Lobanova; Oleg Nakovkin; Marina Levitskaya; Lyudmila Menovschikova; Andrey Fisenko

doi:10.5281/zenodo.8104913

Authors

Sergey Zorkin
Aleksey Gusev
Aleksandra Gurskaya
Sergey Karpachev
Rimir Bayazitov
Ekaterina Ekimovskaya
Inna Karnuta
Dinara Akhmedova
Mariya Sulavko
Antonina Lobanova
Oleg Nakovkin
Marina Levitskaya
Lyudmila Menovschikova
Andrey Fisenko

DOI:

https://doi.org/10.5281/zenodo.8104913

Keywords:

Acute kidney injury, chronic kidney disease, Cohen's operation, laparoscopic pneumovesicum, posterior urethral valves, transurethral incision

Abstract

Objective: Posterior urethral valves are a rare but the most common cause of lower urinary tract obstruction in male newborns and infants. Patients are at high risk of recurrent urinary tract infections, acute kidney injury and chronic kidney disease. The aim of this study was to present our experience of transurethral incision of posterior urethral valves in newborns as a gold standard of treatment.

Materials and methods: We conducted a case-series of patients with posterior urethral valves who underwent transurethral incision during 2017–2021. We analyzed clinical characteristics of patients, recurrence, and complications during a follow-up of 3-12 months.

Results: Of 26 patients who underwent transurethral incision of posterior urethra valves 14 had concomitant vesicoureteral reflux of II-V degrees and 12 – obstructive megaureter. Eight children received endoscopic injections (7 ureters) and ureteral stenting (5 ureters). Six infants (9 ureters) had Cohen's operation of which 4 patients had ureteric reimplantation using laparoscopic pneumovesicum and 2 patients underwent open procedure. In 4 cases we performed laparoscopic nephroureterectomy. In 12 children a spontaneous regression of VUR and megaureter within 3 months after TUI were observed. Four children developed chronic kidney disease of 1-2 stages.

Conclusions: Early diagnosis and surgery treatment of posterior urethra valves in newborns and infants provide excellent outcomes in most patients. Cystourethroscopy with the transurethral incision is highly recommended to be performed in the neonatal period as the spontaneous recovery of concomitant vesicoureteral reflux and megaureter are quite often.

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