The diagnosis and treatment of neonates and infants with posterior urethral valves

Abstract

In January 2009 to December 2013, the N.F. Filatov Children’s City Clinical Hospital (CCCH) Thirteen gave 357 consultations to pregnant women with fetal urinary tract abnormalities and identified the signs of infravesical obstruction in 27 fetuses of 28–32 weeks of gestation. During the first 24 hours of life, these babies were urgently admitted from maternity hospitals to the Unit for Surgery of Neonates and Premature Babies for further examination and treatment. The diagnosis was verified by miction cystourethrography that showed posterior urethral enlargement. Comprehensive X-ray urological examination and blood biochemical tests were carried out in the unit to evaluate renal function. For additional assessment of the latter, urinary enzymes and β2-microglobulins were examined and biochemical urinalysis was performed from September 2012. All the infants underwent transurethral resection of a posterior urethral valve. Later on, the babies were followed up and treated in an outpatient setting in the Nephrourological Center, N.F. Filatov CCCH Thirteen. The duration of the follow-up was 1 to 4 years. Analysis of the long-term results of endoscopic correction of ureterovesical segment abnormality shows that the use of mini-invasive treatment options in neonates and infants makes it possible to recover urinary tract urodynamics and bladder evacuation function, to reduce the number of infectious complications, and to prevent reflux nephropathy and chronic kidney disease.

Keywords

• neonatal infants
• posterior urethral valve
• transurethral resection of posterior urethral valve
• neurogenic bladder dysfunction