Role of alpha adrenergic blocker in the management of posterior urethral valves.

PURPOSE: To evaluate the effect of Terazosin (alpha1 adrenergic blocker) on bladder emptying in children with posterior urethral valves. MATERIALS AND METHODS: Forty-two children with significant post void residual urine after valves ablation were placed on Terazosin ranging from 0.25 to 2 mg. Post void urine at the commencement and at follow up was monitored with abdominal ultrasound. RESULTS: Post void residual urine significantly reduced in 40 patients (95%) who were put on Terazosin. Mean pretreatment PVR was 15.7 ml and mean PVR at the last follow up was 2.4 ml (P = 0.000). This was a reduction of 85% in the pretreatment post void residual urine volume. All the patients had improvement in urinary stream. One patient reacted to Terazosin with hypotension necessitating its withdrawal. Mean follow up was 17 months. CONCLUSION: Terazosin has proved to be safe and results in significant improvement in bladder emptying in our patients with posterior urethral valves. Randomized controlled trial and long-term follow up are necessary to further define the role of alpha1 adrenergic blocker therapy in children with posterior urethral valves. This study will become the justification for such a study.

Experience with laparoscopy-assisted retroperitoneal pyeloplasty in children.

PURPOSE: To describe a laparoscopy-assisted retroperitoneal pyeloplasty (LARP) and results of initial experience. METHODS: Port placement used by Farhat in retroperitoneal-assisted laparoscopic pyeloplasty was modified for better cosmetic results. Surgery was done using 2-cm incision for 5-mm camera port and two 3-mm working ports. Dissection was done anterior to the kidney. The ureteropelvic junction was brought out through the 2-cm trocar site and the pyeloplasty was performed extracorporeally. Between January 2004 and February 2008, a total of 39 kidneys in 38 children with mean age of 4.1 months underwent LARP. The operative time, hospital stay, functional outcome and follow-up renogram studies were reviewed. RESULTS: The mean operative time was 147 min. 2-cm incision was extended in one patient with malrotated kidney. There was improvement in function in 37 (95%) with no failure. The mean split renal function, preoperative and at follow-up were 35.7 and 44.2%, respectively (P = 0.000). The mean glomerular filtration rate (ml/min), preoperative and at follow-up were 27.4 and 39.1%, respectively (P = 0.000). Mean follow-up period was 24 months. CONCLUSION: LARP is safe in treating UPJ obstruction in infants. It is recommended especially in small babies where laparoscopic pyeloplasty is difficult.

Posterior urethral valves: a single center experience over 7 years.

PURPOSE: To evaluate the outcome of management of 65 consecutive children with posterior urethral valves (PUV) using two techniques of valves ablation. METHODS: Retrospective review of 65 consecutive children with PUV managed over 7 years. There were two groups based on the methods of valves ablation: either Mohan's urethral valvotome for primary cases or electrocautery fulguration for patient with previous intervention. Serum electrolyte and serial post-void residue (PVR) were monitored in outpatient clinic. Alpha-blockers were started in all cases with high PVR. Management outcome of patient who had valves ablation with Mohan's valvotome were compared with those who had endoscopy fulguration. RESULTS: Sixty-one patients were regular on follow-up with a median age at presentation of 45 days. Nineteen (31%) patients were diagnosed antenatally. There were 32 refluxing ureters in 26 patients; 58 (95%) underwent primary valve ablation (37 with Mohan's urethral valvotome, 21 fulguration). Reflux disappeared in 10 (36%) refluxing ureters. There were five (8.2%) urethral strictures (all five in fulguration group), eight residual valves (four in each group), and three recurrent urinary tract infections. Three patients had nephrectomy and one patient had renal transplantation. There was no death. The mean serum creatinine for all the patients at presentation and at the last follow-up were 1.2 and 0.5 mg/dl, respectively (P = 0.031). At follow-up, mean PVR of valvotome group was 2.5 ml and fulguration group was 2 ml (P = 0.282). The median follow-up period was 24 months. CONCLUSIONS: Early ablation of PUV and detailed attention to bladder management gives a better outcome. With Mohan's valvotome incidence of stricture is less and incidence of residual valves is comparable to endoscopic ablation of PUV.