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Adolescent Presentation of Posterior Urethral Valves
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Adolescent Presentation of Posterior Urethral Valves Roni Manyevitch , Wayland J. Wu , Rachel Davis , Hiten D. Patel , Heather N. Di Carlo , John P. Gearhart PII: DOI: Reference:
S0090-4295(19)31018-0 https://doi.org/10.1016/j.urology.2019.11.014 URL 21860
To appear in:
Urology
Received date: Revised date: Accepted date:
25 October 2019 11 November 2019 12 November 2019
Please cite this article as: Roni Manyevitch , Wayland J. Wu , Rachel Davis , Hiten D. Patel , Heather N. Di Carlo , John P. Gearhart , Adolescent Presentation of Posterior Urethral Valves, Urology (2019), doi: https://doi.org/10.1016/j.urology.2019.11.014
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc.
Adolescent Presentation of Posterior Urethral Valves Roni Manyevitch1, Wayland J. Wu1, Rachel Davis1, Hiten D. Patel1, Heather N. Di Carlo1, John P. Gearhart1 1. Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
Word Count Abstract/Manuscript: 96/157 Figures: 3 Key Words: Posterior urethral valves; Bladder outlet obstruction; Urinary retention Financial Disclosures: The authors declare that they have no relevant financial interests. Corresponding author: John P. Gearhart, MD The Johns Hopkins University School of Medicine The James Buchanan Brady Urological Institute Robert D. Jeffs Division of Pediatric Urology Charlotte Bloomberg Children's Center 1800 Orleans St, Suite 7304 Baltimore, MD 21287 E‐mail: [email protected]
Abstract: Posterior urethral valves (PUVs) present clinically across a varied spectrum, ranging from severe obstruction with massive distension of the bladder and upper urinary tracts in the fetus, to a much more indolent course with minor secondary changes in the young or older child. Type III (diaphragm) PUVs are relatively uncommon, and are associated with difficulty in passing a transurethral catheter into the bladder as well as smooth dilation of the bladder. 1,2 The following case examines the unusual experiences of both diagnosing PUVs in a teenager, and capturing visual evidence of type III valves during cystourethroscopy.
Case: A 15-year-old male with noncontributory medical or antenatal history presented to the emergency department with the inability to void and abdominal distension. Diagnosis of urinary retention was made and eventually a suprapubic tube was placed after difficult, and ultimately failed, transurethral catheterization. Voiding urethrocystogram was remarkable for 1.5 cm dilation of the prostatic urethra to the base of the penis, consistent with bladder outlet obstruction (Figure 1). The remainder of his workup including ultrasonography and serum creatinine was unremarkable. In the operating suite, cystourethroscopy identified type III PUVs (Figure 2) which were resected (Figure 3). Currently, the patient has stable renal function and is able to void without obstructive symptoms.
Commentary: Type III PUVs are likely the result of a persistent urogenital membrane. They are rarely this well preserved on cystoscopic view due to attempted or successful transurethral catheterization.3 Diagnosis of PUVs, although uncommon in this age group, should be entertained in cases of pediatric male urinary retention.
References: 1. Young HH, Frontz WA and Baldwin JG: Congenital Obstruction of the Posterior Urethra. Journal of Urology 1919; 3: 289–366. 2. Rosenfeld B, Greenfield SP, Springate JE, et al: Type III posterior urethral valves: Presentation and management. Journal of Pediatric Surgery 1994; 29: 81–85. 3. Dewan PA, Zappala SM, Ransley PG, et al: Endoscopic Reappraisal of the Morphology of Congenital Obstruction of the Posterior Urethra. British Journal of Urology 1992; 70: 439–444.
Figure Legends:
Figure 1: Voiding cystourethrogram, oblique view, with suprapubic catheter in situ.
Figure 2: Endoscopic view of type III (diaphragm) posterior urethral valves.
Figure 3: Patent urethra post-resection of valves.
Adolescent Presentation of Posterior Urethral Valves Roni Manyevitch , Wayland J. Wu , Rachel Davis , Hiten D. Patel , Heather N. Di Carlo , John P. Gearhart PII: DOI: Reference:
S0090-4295(19)31018-0 https://doi.org/10.1016/j.urology.2019.11.014 URL 21860
To appear in:
Urology
Received date: Revised date: Accepted date:
25 October 2019 11 November 2019 12 November 2019
Please cite this article as: Roni Manyevitch , Wayland J. Wu , Rachel Davis , Hiten D. Patel , Heather N. Di Carlo , John P. Gearhart , Adolescent Presentation of Posterior Urethral Valves, Urology (2019), doi: https://doi.org/10.1016/j.urology.2019.11.014
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc.
Adolescent Presentation of Posterior Urethral Valves Roni Manyevitch1, Wayland J. Wu1, Rachel Davis1, Hiten D. Patel1, Heather N. Di Carlo1, John P. Gearhart1 1. Robert D. Jeffs Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
Word Count Abstract/Manuscript: 96/157 Figures: 3 Key Words: Posterior urethral valves; Bladder outlet obstruction; Urinary retention Financial Disclosures: The authors declare that they have no relevant financial interests. Corresponding author: John P. Gearhart, MD The Johns Hopkins University School of Medicine The James Buchanan Brady Urological Institute Robert D. Jeffs Division of Pediatric Urology Charlotte Bloomberg Children's Center 1800 Orleans St, Suite 7304 Baltimore, MD 21287 E‐mail: [email protected]
Abstract: Posterior urethral valves (PUVs) present clinically across a varied spectrum, ranging from severe obstruction with massive distension of the bladder and upper urinary tracts in the fetus, to a much more indolent course with minor secondary changes in the young or older child. Type III (diaphragm) PUVs are relatively uncommon, and are associated with difficulty in passing a transurethral catheter into the bladder as well as smooth dilation of the bladder. 1,2 The following case examines the unusual experiences of both diagnosing PUVs in a teenager, and capturing visual evidence of type III valves during cystourethroscopy.
Case: A 15-year-old male with noncontributory medical or antenatal history presented to the emergency department with the inability to void and abdominal distension. Diagnosis of urinary retention was made and eventually a suprapubic tube was placed after difficult, and ultimately failed, transurethral catheterization. Voiding urethrocystogram was remarkable for 1.5 cm dilation of the prostatic urethra to the base of the penis, consistent with bladder outlet obstruction (Figure 1). The remainder of his workup including ultrasonography and serum creatinine was unremarkable. In the operating suite, cystourethroscopy identified type III PUVs (Figure 2) which were resected (Figure 3). Currently, the patient has stable renal function and is able to void without obstructive symptoms.
Commentary: Type III PUVs are likely the result of a persistent urogenital membrane. They are rarely this well preserved on cystoscopic view due to attempted or successful transurethral catheterization.3 Diagnosis of PUVs, although uncommon in this age group, should be entertained in cases of pediatric male urinary retention.
References: 1. Young HH, Frontz WA and Baldwin JG: Congenital Obstruction of the Posterior Urethra. Journal of Urology 1919; 3: 289–366. 2. Rosenfeld B, Greenfield SP, Springate JE, et al: Type III posterior urethral valves: Presentation and management. Journal of Pediatric Surgery 1994; 29: 81–85. 3. Dewan PA, Zappala SM, Ransley PG, et al: Endoscopic Reappraisal of the Morphology of Congenital Obstruction of the Posterior Urethra. British Journal of Urology 1992; 70: 439–444.
Figure Legends:
Figure 1: Voiding cystourethrogram, oblique view, with suprapubic catheter in situ.
Figure 2: Endoscopic view of type III (diaphragm) posterior urethral valves.
Figure 3: Patent urethra post-resection of valves.