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Adult posterior urethral valve: a case report

Kilciler M, Basal S, Irkilata HC, Zor M, Istanbulluoglu MO, Dayanc M - Ger Med Sci (2010)

Bottom Line: During cystoscopy mild bladder trabeculation and resected bladder neck were seen.While the cystoscope was taken off, PUV were obtained.Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.

Affiliation: Gülhane Military Medical Academy, Department of Urology, Kecioren, Ankara, Turkey.

ABSTRACT

Introduction: Posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra with an incidence of 1/8,000 to 1/25,000 live births. PUV is the most common cause of lower urinary tract obstruction in neonates. The diagnosis of PUV is usually made early, and PUV cases have rarely been detected in adults.

Case presentation: Here we report the case of a 35 years old man presented with obstructive urinary symptoms. In spite of bladder neck rejection uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s in uroflowmetry. During cystoscopy mild bladder trabeculation and resected bladder neck were seen. While the cystoscope was taken off, PUV were obtained.

Conclusion: Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.

Ablation of posterior urethral valve with Collins knife
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Figure 2: Ablation of posterior urethral valve with Collins knife

Mentions: A 35 years old male patient presented with lower urinary tract symptoms for a long time. His complaints increased for the last two years. Because of this symptoms, transurethral bladder neck resection was performed one year ago, but his symptoms did not disappear. Biochemical analysis, hemogram and urinalysis were normal and urine culture was sterile. Sonography of kidney, bilateral ureter, bladder and prostate were normal. Uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s. Postvoid residual urine was measured 60 ml by bladder scan. We performed cystourethroscopy to find out the reason of obstruction. During cystourethroscopy mild bladder trabeculation and resected bladder neck were seen. At the beginning we could not find any urethral pathology. After filing bladder we inspected the urethra, while taking out the cystoscope, PUV was incidentally determined (Figure 1 (Fig. 1)). In order to verify if it was true PUV or urethral folding, valves were hooked with Collins knife (Figure 2 (Fig. 2), Figure 3 (Fig. 3)). Patient symptoms disappeared and complete emptying of the bladder were determined after 3 months of operation, with normal voiding pattern and max. flow rate 16 ml/s and average flow rate 10 ml/s in uroflowmetry. No postvoid residual urine was detected.

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Adult posterior urethral valve: a case report

Kilciler M, Basal S, Irkilata HC, Zor M, Istanbulluoglu MO, Dayanc M - Ger Med Sci (2010)

Ablation of posterior urethral valve with Collins knife
© Copyright Policy
Figure 2: Ablation of posterior urethral valve with Collins knife
Mentions: A 35 years old male patient presented with lower urinary tract symptoms for a long time. His complaints increased for the last two years. Because of this symptoms, transurethral bladder neck resection was performed one year ago, but his symptoms did not disappear. Biochemical analysis, hemogram and urinalysis were normal and urine culture was sterile. Sonography of kidney, bilateral ureter, bladder and prostate were normal. Uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s. Postvoid residual urine was measured 60 ml by bladder scan. We performed cystourethroscopy to find out the reason of obstruction. During cystourethroscopy mild bladder trabeculation and resected bladder neck were seen. At the beginning we could not find any urethral pathology. After filing bladder we inspected the urethra, while taking out the cystoscope, PUV was incidentally determined (Figure 1 (Fig. 1)). In order to verify if it was true PUV or urethral folding, valves were hooked with Collins knife (Figure 2 (Fig. 2), Figure 3 (Fig. 3)). Patient symptoms disappeared and complete emptying of the bladder were determined after 3 months of operation, with normal voiding pattern and max. flow rate 16 ml/s and average flow rate 10 ml/s in uroflowmetry. No postvoid residual urine was detected.

Bottom Line: During cystoscopy mild bladder trabeculation and resected bladder neck were seen.While the cystoscope was taken off, PUV were obtained.Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.

Affiliation: Gülhane Military Medical Academy, Department of Urology, Kecioren, Ankara, Turkey.

ABSTRACT

Background:

Introduction: Posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra with an incidence of 1/8,000 to 1/25,000 live births. PUV is the most common cause of lower urinary tract obstruction in neonates. The diagnosis of PUV is usually made early, and PUV cases have rarely been detected in adults.

Case presentation: Here we report the case of a 35 years old man presented with obstructive urinary symptoms. In spite of bladder neck rejection uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s in uroflowmetry. During cystoscopy mild bladder trabeculation and resected bladder neck were seen. While the cystoscope was taken off, PUV were obtained.

Conclusion: Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.

View Similar Images In: Results  - Collection
View Article: Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2850585&rFormat=json&query=null&req=5