Memoire Online - Posterior urethral valves in children: a review of 28 cases in Yaounde, Cameroon

Incontinence is a frequent complaint of patients treated for posterior urethral valves. It was present in 8 cases (29%) in our series. It occurred in 19% of patients in

CONNOR and BURBIGE's study (53). According to COCHAT (19) it is present in 10-30% of cases of PUV and gradually disappears after puberty, following growth of the prostatic tissue. Formerly it was thought to be due to surgical trauma on the bladder neck and distention of urethral musculature bladder dysfunction (53, 9). The loss of urine concentrating ability leading to large volumes of dilute urine, has been reported in boys with PUV (54). The combination of polyuria with poor bladder dysfunction or compliance almost inevitably causes incontinence (10, 54). Therapy includes, clean intermittent catheterization and anticholinergic medications. Augmentation cystoplasty may be needed in case of high intravesical pressures despite anticholinergic therapy (19, 54).

Despite our efforts to request parents to bring their children for follow-up, we were very disappointed with the poor turn out. Of the 22 patients not known to have died at the beginning of the study only 12 came, but then only 9 were able to do simple renal function tests as BUN and creatinine not to talk of control ultrasounds and cystourethrograms. The other 3 went away promising to come back at least with results of BUN and creatinine but they are yet to return. One patient who had vesicostomy at the age of 3 weeks and was lost to follow-up turned up after receiving our message. Although he was doing fine and going to school with the renal function satisfactory (GFR 4 ml/min/1.73m² at 3 weeks of age to 92 ml/min/1..73m² at the age of 6 years) there was already stomal stenosis. The mother promised to bring him back for closure of the vesicostomy but is yet to come.

The mean number of follow - up visits was 3 (range 0-10) which is not adequate. It is undoubted that more than 28 patients with posterior urethral valves were managed in the three hospitals from 1985 to 1997 but poor keeping of patient records in the archives didn't permit us to have more. Simple information as address, weights, heights, laboratory and radiological investigations were lacking in most files.

> That the ammiotic fluid be carefully assessed as part of routine prenatal visits. In case of oligohydramnios, obstructive uropathy should be suspected and an ultrasound requested so that management should be started at least soon after birth. While in some series (31) more than 40% of PUV are diagnosed in the first month of life, 50% of our cases were diagnosed above 1 year with a mean age at diagnosis of 2.9 years

> That PUV should not be regarded as a rare entity in Cameroon. We are convinced that there are many more undiagnosed cases in our health institutions. As CAMPBELL stated (cited in 35) «Prostatic urethral valves are not rare, they are just rarely identified».

> that the complications of PUV be well understood and management known. Three patients died of septicaemia and two of post -obstructive diuresis . These deaths could have at least been reduced if appropriate measures were taken promptly.

> Any child with a urinary tract infection or suspected symptoms should benefit from urine cultures and radiological investigations (at least ultrasonography) because these could be first manifestations of obstructive uropathy.

> The urinary stream of children should be clinically evaluated during routine consultations and any abnormal stream should be investigated. We were unable to recruit a 32 year old man (because he was out of town) who had been undergoing hemodialysis for chronic renal failure and was diagnosed and treated for PUV at the age of 21 years. He has been having mild symptoms since infancy and these did not draw attention towards PUV.

This is an illustration of mild cases which evolve undiagnosed to end - stage renal failure and as HENDREN (37) rightly states: «the picture as usually described is but one end of a spectrum and that there are many less severe and dramatic cases which escape recognition».

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who had Urinary tract problems and was followed -up by Dr ANGWAFO, for a control check -up.

This control examination is free -of - charge and even urgent because these children might develop long - term complications.

You should contact Dr CHIABI Andreas (Paediatric resident) in the Paediatric service of the Yaounde General Hospital if you come before March 1997; if later contact me in the Pediatric service of the Yaounde Central Hospital Pavillon Jeanne Irene BIYA.

Weight: P50: Height:		P50:	BSA:
	No [ 1	Ext. Urogenital Malformations: Yes [ 1 Type :

		Abdominal Mass: Yes [ 1 Location:
	No [ 1l	Others:
		V. INVESTIGATIONS

CBC: WBC: PN:		PL:
RBC :
FIB: MCV:
Urine Culture: Positive: [ ] Negative: [	]
Germ :
WBC: RBC:
BUN: Creatinine:
Creatinine Clearance:
K+ Na+		CL

Ultra Sound: Antenatal: Yes [ ] No [ ]
Normal [ ] Abnormal [ ] Postnatal:	Precise:
	YES [ ] [ ] [ ] [ ]	NO [ ] [ ] [ ] [ ]
Amenorhoea: -Uretero Hydronephrosis: Trabeculated bladder: Dilated post. urethral: Renal cortex:
Renal size:
Others :
Voiding Cystourethrogram	YES [ ] [ ] [ ] [ ]	NO [ ] [ ] [ ] [ ]
VUR Trabeculated bladder Dilated post. urethra Presence of valve Others:

IVP --Normal Uretero Hydronephrosis Yes [ ] No [ ]
Stage:
Symetry: Yes [ ] No [ ]
Late secretion: Yes .[ ] No [ ] Others:

Posterior urethral valves in children: a review of 28 cases in Yaounde, Cameroon

VII. INCONTINENCE