Surgical Management of Lower Urinary Tract Obstruction. Prof. O.B. SHITTU. CONSULTANT UROLOGIST.

Pre- Test ‘Gold standard’ investigation for the diagnosis of Posterior urethral valves Isotope renal Scintigraphy Urethrocystoscopy Retrograde urethrogram (RUG) Voiding cystourethrography (VCUG) Cystometrograph.

Answer True or False Pre-natal diagnosis and treatment of Posterior urethral valves make the long term outcome better

In a child with posterior urethral valves, initial catheterisation is best done with Foley catheter Infant feeding tube Coude catheter De Peezer catheter Malecot catheter

Which of the following is not part of the lower urinary tract Fossa navicularis Prostatic urethra Pelvi-ureteric junction Bladder Bulbar urethra.

Aetiological Factors. Congenital causes Bladder neck stenosis Posterior urethral polyp Posterior urethral valves Congenital urethral stricture Meatal stenosis/stricture

Aetiological Factors. Acquired causes post-traumatic strictures Fall-astride/pelvic fracture Catheter induced stricture Stones Phimosis/Para-phimosis

Posterior Urethral Valves. POSTERIOR URETHRAL VALVES ARE OBSTRUCTING MEMBRANES WITHIN THE LUMEN OF THE URETHRA, EXTENDING FROM THE VERUMONTANUM DISTALLY. OCCUR ONLY IN BOYS. COMMONEST CAUSE OF BLADDER OUTLET OBSTRUCTION AT UCH, IBADAN.

Posterior Urethral valves.

Posterior Urethral Valves: Epidemiology. INCIDENCE: 1/ 5000 – 8,000 male infants. 1/1,250 by recent foetal Uss. GENETICS: debatable, but have been seen in siblings.

Posterior Urethral Valves: Clinical presentation. PRE-NATAL PRESENTATION: Distended, thick walled foetal bladder. Hydronephrosis. Oligohydramnios. Most of the amniotic fluid after the 16th/52 of gestation depend on the foetal urine. Oligohydramnios would suggest primary renal impairment or obstruction.

Posterior Urethral Valves: Clinical presentation. POST- NATAL DIAGNOSIS: TIME AND MODE OF PRESENTATION WOULD DEPEND ON THE SEVERITY OF THE CONDITION. RESPIRATORY DISTRESS. URAEMIA AND SEPSIS. ABDOMINAL DISTENTION. DIFFICULTY WITH MICTURITION.

Posterior Urethral Valves: Clinical presentation. TREAT ACUTE, ASSOCIATED PROBLEMS. RELIEVE UPPER TRACT OBSTRUCTION. INVESTIGATE TO ESTABLISH DIAGNOSIS. VCUG- ‘Gold standard’

Poterior Urethral Valves: Clinical presentation. Features that can be seen on VCUG. Dilated,thick walled, trabeculated bladder Elongated and dilated prostatic urethra with narrow bladder neck. Folds of valves could be seen as filling defects from the area of the verumontanum. VUR, diverticula, pseudoresidual, etc. Valves unilateral reflux and renal dysplasia syndrome. (VURD)

MCUG in a Child.

Posterior Urethral Valves: Treatment. PRIMARY VALVES ABLATION. VESICOSTOMY AND DELAYED VALVES ABLATION. TEMPORARY UPPER TRACT DIVERSION.

Posterior Urethral Valves: Long term management. VESICO URETERIC REFLUX. Prophylactic antibiotic cover. Ureteric re-implantation.

Posterior Urethral Valves: Long term Management. URINARY INCONTINENCE: INCOMPLETE VALVE ABLATION. URETHRAL STRICTURE. NON-COMPLIANT BLADDER. RENAL INSUFFICIENCY.

Posterior Urethral Valves: Long-term renal insufficiency. POLYURIA SALT-LOSING NEPHROPATHY METABOLIC ACIDOSIS RENAL OSTEODYSTROPHY GROWTH RETARDATION