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Congenital anterior urethral valves and diverticula

      Highlights

      • Visible swelling within the ventral part of penis during micturation should suggest possibility of an anterior urethral valve (AUV) and urethral diverticulum.
      • Voiding cystourethrography and cystoscopy are the preferred diagnostic investigations.
      • Urinary obstruction, renal dysfunction and urosepsis are possible consequences of AUVs.

      Abstract

      Aims of Study

      Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options.

      Method

      Single centre, retrospective study of children.

      Result

      Over a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously.

      Conclusion

      AUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent.

      Level of Evidence

      Level IV.

      Keywords

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