Evaluation, management and follow up of vesicoureteric reflux in the setting of posterior urethral valve

Introduction: Posterior urethral valve represents the most common etiology of congenital urethral obstruction in boys. 35-50% of PUV cases have vesicoureteric reflux at the time of diagnosis. Endoscopic ablation of valves is the treatment of choice. In this study we evaluated the association of primary kidney function and VUR in patients with PUV and assessed the rate and timing of resolution of VUR after valve ablation. Materials and Methods: A prospective, observational study was done in which children with VUR secondary to PUV were included. A clinical history was taken. Preoperative work up with complete blood picture, renal function tests, ultrasonography, voiding cystourethrogram was done. All patients underwent cystoscopy and fulguration of the posterior urethral valves. The patients were followed up with ultrasound, MCUG and DMSA scan. Resolution of VUR was studied. Results: 56 patients were included in the study. 38 out of 56 cases had an antenatal history of HDN. Bilateral VUR was seen in 33 cases (59%).  Unilateral VUR was seen in 23 cases. Each side of reflux was considered as an individual unit in bilateral cases.The total number of units was 89. Resolution of reflux was seen in 27 units. Downgrading of reflux was seen in 53 units. 9 units neither showed resolution nor downgrading. Conclusion: VUR is the major cause of postnatal damage in PUV. Early resolution of reflux after valve ablation was seen in cases with low grade reflux. Resolution of reflux is more in cases with unilateral reflux than with bilateral reflux.&nbsp