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CASE REPORT |
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| Year : 2004 | Volume
: 20
| Issue : 2 | Page : 182-183 |
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A rare presentation of posterior urethral valves in adults
Nagesh Kamat
Kamats Kidney Hospital, Kothi, Baroda, India
Correspondence Address:
Nagesh Kamat
Kamats Kidney Hospital, Opposite Government Press, Kothi, Baroda - 390 001
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Posterior urethral valves, adults, stricture urethra.
How to cite this article:
Kamat N. A rare presentation of posterior urethral valves in adults. Indian J Urol 2004;20:182-3 |
 Case Report | |  |
A 20-year-old male presented with difficulty in passing urine. He was completely alright at the age of 9 when he had complaints of straining and dribbling. Since that age the patient had undergone urethral dilatation many times but the obstructive urinary complaints persisted. He was investigated and treated at various centres, but a micturating cystourethrogram (MCUG) was never done as a catheter could not be negotiated beyond the strictured meatus. When the patient presented to us he was suffering from obstructive urinary problems for the past 11 years. Examination of the penis revealed a' sclerosed and scarred external urethral meatus, and a chord like fibrosed urethra was palpable. Working on a provisional diagnosis of urethral stricture due to the evident local examination findings, a retrograde urethrogram [Figure - 1] was performed which showed a narrow, sclerosed, and nondistensible anterior urethra. To complete the study, a micturating urethrogram was performed by instilling contrast into the bladder with a suprapubic needle puncture. The findings came as a surprise as the MCUG [Figure - 2] showed a grossly dilated posterior urethra suspicious of a missed posterior urethral valve (PUV). The bladder walls were uniform and regular and there was no reflux. Ultrasound confirmed the dilated posterior urethra but the kidneys and the ureters were undilated.
A diagnostic urethroscopy was impossible due to the sclerosed urethra. So a first stage of Johannsons type urethroplasty with diagnostic urethroscopy through the perineal stoma, and fulguration of the posterior urethral valves was planned. The urethra was opened up to the proximal bulbar urethra. On urethroscopy from this level, the fleshy posterior urethral valves were visualised and resected with a Storz 26F resectoscope and a cutting loop. A horseshoe flap was tunneled in to the posterior urethra to form the margins of the perineal urethrostomy. A diverting suprapubic cystostomy was placed. Postoperative recovery was uneventful, and the patient passed urine with a good stream. The patient is planned for the second stage urethroplasty after six months.
| Comments | | |
Posterior urethrla valves presenting in adults have been described frequently in literature. [1],[2],[3] but this is the first case report where its presentation is superimposing that of an urethral stricture. The diagnosis of a posterior urethral valve was additionally suspected because the patient gave a history of the onset of the obstructive urinary complaints since his childhood. Despite the various urethral manipulations and dilatations, the patient never had a satisfactory stream, even immediately after the procedure. It is likely that the urethral stricture was iatrogenic. The strong suspicion of a congenital cause compelled us to aggressively search for the posterior urethral valve, and we were rewarded with the findings on the MCUG. It is also possible that the other clinicians were discouraged from performing the micturating urethrogram due the inability to pass the catheter perurethrally, due the dense stricturous urethra. The corrective surgery was planned in such a way that the stricture could be treated, and at the same time the PUV could be visualized and resected. The postoperative result was excellent, and the urine flow after the first stage urethroplasty and PUV resection was very good. A vigilant history elicitation, and aggressive MCUG picked up the hidden PUV.
| References | | |
| 1. | Bomalaski MD. Anema JG. Coplen DE. Koo HP, Rozanski T. Bloom DA. Delayed presentation of posterior urethrla valves: a not so benign condition. J Urol 1999; 162: 2130-2.  |
| 2. | Heaton ND, Kadow C, Yates-bell AJ. Late presentation of congenital posterior urethral valves. Br J Urol 1989: 64: 98. |
| 3. | Opsomer RJ, Wese FX, Dardenne AN, Van Cangh PJ. Posterior urethral valves in adult males. Urology 1990: 36: 35-37. |
[Figure - 1], [Figure - 2]
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