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| CASE REPORT |
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| Year : 1995 | Volume
: 41
| Issue : 2 | Page : 46-7 |
Anterior urethral valve in an adolescent boy.
SV Punekar, NR Rao, AR Kelkar, PM Gavande, AR Prem
Department of Urology, KEM Hospital, Mumbai, Maharashtra.
Correspondence Address:
S V Punekar
Department of Urology, KEM Hospital, Mumbai, Maharashtra.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0010707710 
A 14 year old boy with a relatively uncommon anterior urethral valve is described herein.
Keywords: Adolescent, Case Report, Diverticulum, etiology,surgery,ultrasonography,Human, Male, Pyuria, diagnosis,etiology,Treatment Outcome, Urethra, abnormalities,surgery,ultrasonography,Urethral Obstruction, etiology,surgery,ultrasonography,Urodynamics, Urologic Surgical Procedures, methods,
How to cite this article:
Punekar S V, Rao N R, Kelkar A R, Gavande P M, Prem A R. Anterior urethral valve in an adolescent boy. J Postgrad Med 1995;41:46 |
Anterior urethral valves can be equally damaging though posterior urethral valves are commoner. Awareness can permit accurate diagnosis and early management.
A 14-year-old boy presented with repeated episodes of left flank pain along with fever and chills. Physical examination did not reveal any positive findings. Routine urine examination showed a large number of pus cells. Urine culture revealed significant Esch. Coli colonies, Ultrasonography showed a small contracted (5 x 3 cm) right kidney and left sided hydroureteronephrosis. Intravenous urography revealed non-visualisation of right kidney and left hydronephrosis with hydroureter. Voiding cystourethrogram (V.C.U.) clearly delineated an anterior urethral valve with proximal diverticulum of urethra [Figure:1].
The bladder was trabeculated with grade IV vesicoureteral reflux on right side [Figure:2] Endoscopic examination confirmed the diagnosis. In view of fairly large proximal anterior urethral diverticulum, endoscopic fulguration was preferred to surgical excision, as recommended by Firlit and King'. On exploration a very well defined valve was demonstrated after opening the diverticulum. Excision of valve and diverticulum along with Johanson's urethroplasty was performed. Left ureteroneocystostomy was done subsequently.
The posterior urethral valves are several times commoner than anterior urethral valve yet the obstructive effects of anterior urethral valves can be equally damaging[1]. The patient may present with poor urinary stream, recurrent infections, or with renal failure. Depending on the severity of anatomical obstruction he may present early at birth or later in childhood if obstruction is minimal[1]. The site of anterior valve can be anywhere distal to membranous urethra. The penobulbar junction being the commonest site[3]. Though the exact aetiology is unclear the various theories described include (a) incomplete formation of ventral corpus spongiosum (b) congenital cystic dilatation of periurethral gland and (c) an abortive attempt at urethral duplication[4]. The case being described fits into type IV of Firlit's classification - because of the association with VUR.
The diagnosis of anterior urethral valve can be accurately made if this condition though less common is kept at the back of mind. This is particularly so when more common posterior urethral valves are absent. An oblique plate of VCU along with full length delineation of urethra is the most helpful diagnostic modality. An early, precise diagnosis and awareness of the anterior urethral valves in boys with obstructive symptoms can reduce incidence of advanced uropathies.
| :: References | |  |
| 1. |
Firlit CF, King LP. Anterior urethral valves in children J Urol 1972; 108:972-976.  |
| 2. | Firlit RS, Firlit CF, King LP. Obstructing anterior urethral valves in children. J Urol 1978; 119:819-822. |
| 3. | Golimbu MI, Orca MX, Askari S, Morales P, Golimbu C. Anterior urethral valves, Urology, 1978; 12:343. |
| 4. | Williams DI, Retilk AB. Congenital valves and diverticuli of the anterior urethra. Brit J Urol 1969; 41:228-234.
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