Klappen der hinteren Harnröhre als Ursache von Miktionsbeschwerden im Schulkindalter

Introduction: Posterior urethral valves ( PUV) are know as the most common form of infravesical obstruction in newborn boys. Ususally the diagnosis is made antenatal or during babyhood because of severe hydronephrosis.This study investigated cases of children, who did not present before schoolage with voiding dysfunction, resistent to therapy. PUV have been found as cause of this condition. We analysed 21 cases of PUV in children between 6 and 13 years of age ( average age 8.7 years), who have been treated in the Dept. of Pediatric Urology, University Clinic, Aachen, Germany. Almost all of these children had a history of diagnostics without result and of attempts of treatment without response. We wanted to find out if this rather unknows form of PUV presents with typical symptoms and diagnostic signs and what the expectable outcome of these cases is like.Methods: The children initially underwent routine diagnostics which included an interview, physical exam, micturition protocol, ultrasonography, laboratory diagnostics,uroflow, EMG and ressidual urine. Because of suspected infravesical obstruction and / or because the children did not respond to conservative treatment a videourodynamic investigation under sedation was opbtained. In case of suspicious findings for PUV a urethrocystoscopy and incision of the valves followed. As postoperative treatment we administered anticholinergic medication in 66,7% of cases and device supported behavioural therapy in 28,6%. The follow-up after incision of the PUV was 8 to 59 month (average 30 month).Results: The children in this study presented in 95% of cases with nocturnal enuresis, not responding to conservative treatment, in 90% of cases combined with daytime symptoms like frequency, urgency and enuresis diurna. 30% of our cases presented with additional urinary tract infection. Mild or moderate pathological findings of the upper urinary tract occured in 38%. Urodynamic investigation showed a small capacity bladder in 57,1%, in 7,7% combined with instability of the detrusor muscle. Pathologic max. detrusor pressure unter micturation (in average 132 cm H2O) occured in 100% of cases.After incision of PUV 85,7% of the children were free of symptoms at the end of the follow-up period. Three boys had mild residual symptoms in form of enuresis nocturna.Discussion: Posterior urethral valves in school age present with typical symptoms, in first place with enuresis nocturna combined with daytime symptoms. The condition seems to be strongly underdiagnosed, which presumably is due to difficulties with the correct interpretation of examination results and an insufficiency in knowledge about this special form of PUV. In case of early diagnosis and adequate treatment the long-range prognosis seems to be very positiv. Further selected studies about this extensivly underdiagnosed form of PUV are desirable.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2006

Author dc:creator

• Coen, Anna Gabriele

Contributors dc:contributor

• Rohrmann, Dorothea

• info:eu-repo/classification/ddc/610
• Medizin
• Enuresis nocturna
• Harninkontinenz
• Kind
• Urologie
• Harnröhre
• Harnentleerungsstörung
• Miktionsurethrographie
• Uroflowmetrie
• Harnröhrenklappe
• posterior urethral valves
• voiding dysfunction
• pediatric urology
• school age
• daytime wetting
• urinary tract infection

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-122523%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:60835