Article

Anterior urethral valves and diverticula in children: A result of ruptured Cowper's duct cyst?

Harvard University, Cambridge, Massachusetts, United States
BJU International (Impact Factor: 3.13). 09/2004; 94(3):375-8. DOI: 10.1111/j.1464-410X.2004.04854.x
Source: PubMed

ABSTRACT To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity.
Nine cases (all boys; 1963 to 2003) were reviewed retrospectively.
Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice.
This series indicates that the distal lip of a ruptured syringocele may function as a flap-valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.

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    • "On the other hand, patients with AUV have normal corpus spongiosum development (12). McLellan et al. suggested that anterior urethral diverticula may result from rupture of dilated bulbourethral glands (13). In our series, one patient was diagnosed with anterior urethral diverticulum and required resection of diverticulum and staged urethroplasty. "
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    ABSTRACT: Purpose: Anterior urethral valves (AUV) is an unusual cause of congenital obstruction of the male urethra, being 15 to 30 times less common than posterior urethral valves (PUV). It has been suggested that patients with congenital anterior urethral obstruction have a better prognosis than those with PUV.The long term prognosis of anterior urethral valves is not clear in the literature. In this report we describe our experience and long-term follow up of patients with AUV. Materials and methods: We retrospectively identified 13 patients who presented with the diagnosis of AUV in our institutions between 1994 and 2012. From the 11 patients included, we evaluated the gestational age, ultrasound and voiding cystourethrogram findings, age upon valve ablation, micturition pattern, creatinine and clinical follow up. Results: Between 1994 and 2012 we evaluated 150 patients with the diagnosis of urethral valves, where 11 patients (7.3%) had AUV and an adequate follow up. Mean follow up is 6.3 years. 5 patients (45.4%) had pre-natal diagnosis of AUV. The most common prenatal ultrasonographic finding was bilateral hydronephrosis and distended bladder.The mean gestational age was 37.6 weeks. Postnatally, 90% had trabeculated bladder, 80% hydronephrosis and 40% renal dysplasia. The most common clinical presentation was urinary tract infection in 5 patients (45.4%).7 patients (63.6%) had primary transurethral valve resection or laser ablation and 3 patients (27.2%) had primary vesicostomies. One boy (9.1%) had urethrostomy with urethral diverticulum excision. 2 patients (18.2%) developed end-stage renal disease (ESRD). Conclusions: Early urinary tract obstruction resulted in ESRD in 18% of our patient population. In our series, the complication rate and the evolution to renal failure are high and similar to patients with PUV. In patients with AUV we recommend long-term follow up and close evaluation of patient’s bladder and renal function.
    Frontiers in Pediatrics 11/2013; 1:35. DOI:10.3389/fped.2013.00035
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    • "Congenital urethral diverticula in males are rare, and patients can present with poor urinary flow, postmicturition dribbling, urinary tract infections, or penile ballooning in the neonatal and infancy period [2] [3], although later presentations into the teenage years have been known. The aetiology is unknown but theories include a ruptured syringocoele, cystic dilatation of the periurethral glands, and incomplete hypospadias [4]. "
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    ABSTRACT: We present the case of a 13-year-old boy with a congenital anterior urethral diverticulum. This is a rare condition in males which can lead to obstructive lower urinary tract symptoms and urosepsis. Diagnosis is by urethroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Long-term followup is required to check for reoccurrence of the obstruction.
    09/2011; 2011:738638. DOI:10.1155/2011/738638
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    • "The etiology of AUV is still controversial, but faulty union of the glandular and penile urethral segments, incomplete formation of the corpus spongiosum, congenital cystic dilation of the periurethral glands, and abortive attempt at urethral duplication have been proposed as possible mechanisms [1] [2] [4]. AUV can be located anywhere distal to the membranous urethra and, in terms of distribution; these valves are most common in the bulbar urethra (40%) [1] [2] [5]. "
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    ABSTRACT: Association of anterior and posterior urethral valve is a rare congenital anomaly causing lower urinary tract obstruction in children. This paper highlights our experience with a two-month-old boy with double urethral valves. Antenatal ultrasonography failed to detect any abnormality. At the age of 1 month, he presented with urinary dribbling, straining at mic-turition, and febrile urinary tract infection. Clinically, the urethra was dilated at micturition. Diagnosis was confirmed by retrograde urethrogram and urethro-scopy. Endoscopic ablation of both valves was done by electrocautery hook.
    Open Journal of Pediatrics 01/2011; 1:34-36.
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