Clinical Analysis Of 42 Children With Posterior Urethral Valve Disease

BackgroundPosterior urethral valves(PUV)is a common disease of congenital lower urinary tract obstruction in boys.It causes great damage to the children urinary system.Although the incidence of this disease is low,the population base of our country is large,and the number of boys with this disease is still large.In recent years,with the increasing awareness of antenatal care,the widespread popularization of prenatal ultrasound and the improvement of medical technology,the detection rate of posterior urethral valve has increased year after year.The genetic characteristics of the disease are unclear and may be hereditary and may be combined with other system deformities.In antenatal examination,if there is a decrease in amniotic fluid,severe hydronephrosis in the fetus,bladder enlargement and other positive diagnosis,the possibility of posterior urethral valve should be considered,and the basic conditions of the fetus should be evaluated,and whether intrauterine intervention or termination of pregnancy is necessary.After birth,the sick boy will have abnormal urination,repeated urinary tract infection and so on.How to diagnose the posterior urethral valve more quickly and how to choose the operation mode and timing are the problems that need to be solved.The clinical manifestations of posterior urethral valvular disease are mostly abnormal urination,which can seriously affect the life quality of children,and the function of bladder determines the urination of children.Therefore,this article mainly studies the effect of hydronephrosis and ureteral dilatation before and after operation and urinary tract infection on bladder function in children with posterior urethral valvular disease.ObjectiveThe study analyzed in detail the history,clinical manifestations,laboratory and imaging findings,surgical methods,follow-up findings of 42 children with posterior urethral valve,and evaluated the recovery of urinary system and the influence of urinary tract infection on bladder function in children so as to improve the understanding of posterior urethral valve disease,summarize the experience of diagnosis and treatment,and provide some reference for clinical diagnosis and treatment.MethodsThis study collected and analyzed the clinical data of 42 children with posterior urethral valve treated in pediatric urology department of the first affiliated Hospital of Zhengzhou University from January 2012 to January 2017,including age of onset,clinical manifestation,surgical methods,renal function,electrolyte,posterior urethral ultrasound,excretory cystourethrography,urography,urodynamics,etc.In this study,42 children were divided into two groups: urinary infection group(n = 19)and no urinary infection group(n = 23).All patients underwent posterior urethral valve resection under cystoscope(there was no residual valve)and type I posterior urethral valve was clearly diagnosed.The re-examination items should include: to ask the families of children about voiding changes;to review the hospital urinary tract ultrasonography,postoperative electrolytes,renal function,and liver function after 3 months;to review the hospital urinary tract ultrasonography,postoperative urodynamics,electrolyte,renal function and liver function after 6 months.The purpose of re-examination is mainly to understand children's voiding condition,hydronephrosis,ureteral dilatation.If voiding is still not smooth,urodynamics indicates bladder outlet obstruction,cystoscopy and cystectomy should be considered,the urinary bladder compliance(BC)and the maximum urinary flow rate(MFR)should be compared before the operation.ResultsThe postoperative urination was improved significantly,the renal function was normal,the hydronephrosis and ureteral dilatation were mostly alleviated,but a small number of renal pelvis and ureteral dilatation were aggravated.According to the results of urodynamic examination,all 42 cases had different degrees of abnormal urodynamics before and after operation.The results of urodynamic examination between non-urinary infection group and urinary tract infection group before operation was compared.There was no significant difference in age between urinary infection group and non-urinary infection group(P > 0.05).There was significant difference in bladder compliance between non-urinary infection group and urinary tract infection group(P < 0.05).There was significant difference in the maximum uroflow rate between the non-urinary infection group and the urinary tract infection group(P < 0.05).Six months after surgery,the bladder compliance and maximal flow rate of non-urinary tract infection group and urinary tract infection group were all recovered;there was no significant difference in age between urinary infection group and no urinary infection group(P > 0.05);there was significant difference in bladder compliance between non-urinary infection group and urinary tract infection group(P < 0.05);there was significant difference in the maximum uroflow rate between the non-urinary infection group and the urinary tract infection group(P < 0.05).Conclusion1.Urinary tract infection can damage renal function and aggravate bladder dysfunction in children with posterior urethral valve.2.The children after posterior urethral valve operation should be followed up for a long time to understand the bladder function and to make individualized treatment plan.