Endosurgical treatment of newborns and young children with posterior urethral valves

Objective: Posterior urethral valves are a rare but the most common cause of lower urinary tract obstruction in male newborns and infants. Patients are at high risk of recurrent urinary tract infections, acute kidney injury and chronic kidney disease. The aim of this study was to present our experience of transurethral incision of posterior urethral valves in newborns as a gold standard of treatment. Materials and methods: We conducted a case-series of patients with posterior urethral valves who underwent transurethral incision during 2017–2021. We analyzed clinical characteristics of patients, recurrence, and complications during a follow-up of 3-12 months. Results: Of 26 patients who underwent transurethral incision of posterior urethra valves 14 had concomitant vesicoureteral reflux of II-V degrees and 12 – obstructive megaureter. Eight children received endoscopic injections (7 ureters) and ureteral stenting (5 ureters). Six infants (9 ureters) had Cohen's operation of which 4 patients had ureteric reimplantation using laparoscopic pneumovesicum and 2 patients underwent open procedure. In 4 cases we performed laparoscopic nephroureterectomy. In 12 children a spontaneous regression of VUR and megaureter within 3 months after TUI were observed. Four children developed chronic kidney disease of 1-2 stages. Conclusions: Early diagnosis and surgery treatment of posterior urethra valves in newborns and infants provide excellent outcomes in most patients. Cystourethroscopy with the transurethral incision is highly recommended to be performed in the neonatal period as the spontaneous recovery of concomitant vesicoureteral reflux and megaureter are quite often