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Conservatively treated urethral valves
CASE
REPORTS
By Gernot
Brandesky,
M.D.,
Linz,
Austria
Although the treatment of congenital urethral valves 1s generally regarded ah being \urgicsl. jumc authors advocate conservative management using an indwelling urethral catheter.‘,? They believe that pressure effects are rrsponCble for the disappearance of the vaIv~‘s after a few \\eek\ trc.ltment. As many doubt the effectiveness of such conxrvativr mamqemcnt a case verified h! autupq seem% worthwhile reporting. A l&day-old male infant wv;ihadmitted wrth urinary retention and leukocy turia; the bladder \\‘.I\ distended to the umbilicus. E\prcssi~,n-cy\tourethrojiraphy (Fig. IA) showed obstructrve posterior urethral valves and a slightly trabeculated bladder. An intraventruy pyelogram chowed that ~hc upper urmary tract was not dilated. Medical treatment fur the mfcction and insertron 01 an indwelling urethral catheter (Foley. French 8) were instituted. After 4 \\k, cystographic cuntrol showed a normal bladder without residual urine. the distal urethra being unly
Fig. 1. (A) Expression cystourethrogram showi ng posterior gram 6 mo later, after treatment by indwellin 1g uretl oral catheter.
Journal olPed~a?nc Surgery, Vol 8. No 6 (December). 1973
urethral
valves; (B) Cystourethro-
945
CASE
946
REPORTS
Fig. 2. Autopsy specimen of bladder neck and posterior urethra. The left fold is tcBtally exposed; the right is partly covered by the edge of the specimen.
1 .S cm in a tiny pocket (Fig. 2). These folds constituted residues of the original valves and caused no obstruction whatsoever. Microscopic examination of the posterior urethra showed that the mucosal folds were covered by regular transitional epithelium; they contained no muscle fibers and were without inflammatory changes. At about the middle the folds were 0.5-0.7 mm in height and showed minor chronic inflammatory infiltrations (Fig. 3). Further distally the folds diminished and did not project into the urethral lumen. Throughout the entire urethra there was moderate muscle hypertrophy and a slight fibrous broadening of the submucosa with increase of elastic fibers.
ACKNOWLEDGMENT I thank Dr. H. Regele for the microscopic
examinations
of the specimen
and for the photographs.
REFERENCES 1. Bischoff PE: Die angeborenen Blasenentleerungsstarungen und ihre chirurgische Behandlung. Urologe 5:222-228 (1966)
2. Singer H: Personal
communication
‘sqdelljwoqd 0~1 UIOJ) pawnoyy ‘(92 x) A~O~OIS!H ‘E ‘6! j
REPORTS
By Gernot
Brandesky,
M.D.,
Linz,
Austria
Although the treatment of congenital urethral valves 1s generally regarded ah being \urgicsl. jumc authors advocate conservative management using an indwelling urethral catheter.‘,? They believe that pressure effects are rrsponCble for the disappearance of the vaIv~‘s after a few \\eek\ trc.ltment. As many doubt the effectiveness of such conxrvativr mamqemcnt a case verified h! autupq seem% worthwhile reporting. A l&day-old male infant wv;ihadmitted wrth urinary retention and leukocy turia; the bladder \\‘.I\ distended to the umbilicus. E\prcssi~,n-cy\tourethrojiraphy (Fig. IA) showed obstructrve posterior urethral valves and a slightly trabeculated bladder. An intraventruy pyelogram chowed that ~hc upper urmary tract was not dilated. Medical treatment fur the mfcction and insertron 01 an indwelling urethral catheter (Foley. French 8) were instituted. After 4 \\k, cystographic cuntrol showed a normal bladder without residual urine. the distal urethra being unly
Fig. 1. (A) Expression cystourethrogram showi ng posterior gram 6 mo later, after treatment by indwellin 1g uretl oral catheter.
Journal olPed~a?nc Surgery, Vol 8. No 6 (December). 1973
urethral
valves; (B) Cystourethro-
945
CASE
946
REPORTS
Fig. 2. Autopsy specimen of bladder neck and posterior urethra. The left fold is tcBtally exposed; the right is partly covered by the edge of the specimen.
1 .S cm in a tiny pocket (Fig. 2). These folds constituted residues of the original valves and caused no obstruction whatsoever. Microscopic examination of the posterior urethra showed that the mucosal folds were covered by regular transitional epithelium; they contained no muscle fibers and were without inflammatory changes. At about the middle the folds were 0.5-0.7 mm in height and showed minor chronic inflammatory infiltrations (Fig. 3). Further distally the folds diminished and did not project into the urethral lumen. Throughout the entire urethra there was moderate muscle hypertrophy and a slight fibrous broadening of the submucosa with increase of elastic fibers.
ACKNOWLEDGMENT I thank Dr. H. Regele for the microscopic
examinations
of the specimen
and for the photographs.
REFERENCES 1. Bischoff PE: Die angeborenen Blasenentleerungsstarungen und ihre chirurgische Behandlung. Urologe 5:222-228 (1966)
2. Singer H: Personal
communication
‘sqdelljwoqd 0~1 UIOJ) pawnoyy ‘(92 x) A~O~OIS!H ‘E ‘6! j