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Urology (Expert Forum)
Congenital defect, PU valve - surgery
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Congenital defect, PU valve - surgery
by b.balakrishnan, Oct 08, 1999 12:00AM
Sir,
My son B.Kousik, was born in the year 1994. We noticed that he was not urinating properly but was diagnosed as probably urinary infection by the local doctor. He was treated for the same. After the first 5-6 days he completely stopped passing urine and thereafter he was referred to a child specialist. He found that the PU Valve was shut and therefore he was not urinating. He opened the urethra for a year and thereafter performed the closure and the opening of the pu valve. Even after this my son had incontinence and thereafter 2 laporascopic surgeries were carried out for clearing remnants. Since, he still has incontinence, the doctors referred to a urology expert and he said that the Kidneys had hydronephrosis, there was back flow of urine, my son had a over active bladder and the size of the bladder was very small. He was suggested to go on ICC and with a dosage of ditropan & antibiotics. Since he was very small, the treatment would have been very difficult to implement and therefore I took him to a Homeopathic doctor, who has been treating him ever since. He has been treating him for the last 3 years. Though, he has been growing as a normal baby, his stamina is poor, he is lean and still the incontinence is continuing. Now an acupunture specialist is giving him treatment to strengthen his bladder muscles hoping for a better sphincter function. I have not taken any scan during the last 3 years since taking them would only have scared us stiff.
Is the route I have taken reasonable. Is there any treatment possible for his situation
My son B.Kousik, was born in the year 1994. We noticed that he was not urinating properly but was diagnosed as probably urinary infection by the local doctor. He was treated for the same. After the first 5-6 days he completely stopped passing urine and thereafter he was referred to a child specialist. He found that the PU Valve was shut and therefore he was not urinating. He opened the urethra for a year and thereafter performed the closure and the opening of the pu valve. Even after this my son had incontinence and thereafter 2 laporascopic surgeries were carried out for clearing remnants. Since, he still has incontinence, the doctors referred to a urology expert and he said that the Kidneys had hydronephrosis, there was back flow of urine, my son had a over active bladder and the size of the bladder was very small. He was suggested to go on ICC and with a dosage of ditropan & antibiotics. Since he was very small, the treatment would have been very difficult to implement and therefore I took him to a Homeopathic doctor, who has been treating him ever since. He has been treating him for the last 3 years. Though, he has been growing as a normal baby, his stamina is poor, he is lean and still the incontinence is continuing. Now an acupunture specialist is giving him treatment to strengthen his bladder muscles hoping for a better sphincter function. I have not taken any scan during the last 3 years since taking them would only have scared us stiff.
Is the route I have taken reasonable. Is there any treatment possible for his situation
Doctor's Answer
by hfhs M.D.-AK, Oct 12, 1999 12:00AM
Dear Balakrishnan,
In the presence of significant urethral obstruction, ureteral dilation and hydronephrosis are expected. After relief of the obstruction, either by endoscopic destruction of the valve or by vesicostomy (bladder open to skin) the dilation should resolve. When this does not happen, other possibilities must be evaluated. Some urologist agree that it may take many years after primary valve ablation for final improvement in ureteral dilation to occur. The responsible physician should not be anxious to proceed with further surgical therapy as long as renal function is stable and urinary infection is controlled. I would treat your son very similar to the urologist who was taking care of him initially. Your son should have periodic evaluation of his renal function, laboratory values and bladder evaluation. Vesicoureteral reflux and bladder dysfunction are both common in this group of patients. It sound like your son has both and needs to have these two aspect of his care evaluated. I'm not an acupuncturist nor am I a Homeopathic doctor. I speak from the discipline of traditional medical judgement.
The management of a child with posterior urethral valves depends on the degree of renal insufficiency which I do not have any way to assess in your son, and the age. Older children who have voiding dysfunction, which it sounds like your son has, and infections with reasonable renal function, can be observed with periodic check-ups. Decisions about reflux and bladder dysfunction are made on an individual basis.
The prognosis for children with urethral valves is improving. Current management allows for a low death rate, early infection control with appropriate and selective surgical options. It would be important for your son to have a modern urologic evaluation in an effort to take advantage of all that has been learned in the last few years. If nothing else your son deserves to know where his renal fuction stands and be educated on what to expect. Also the modern practice of nephrologic management with dialysis and renal transplantation has improved. My recommendation would be to see the urologic specialist and listen to what he or she has to say. Once you have that information, you can make an informed decision.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword: Posterior urethral valves
.
In the presence of significant urethral obstruction, ureteral dilation and hydronephrosis are expected. After relief of the obstruction, either by endoscopic destruction of the valve or by vesicostomy (bladder open to skin) the dilation should resolve. When this does not happen, other possibilities must be evaluated. Some urologist agree that it may take many years after primary valve ablation for final improvement in ureteral dilation to occur. The responsible physician should not be anxious to proceed with further surgical therapy as long as renal function is stable and urinary infection is controlled. I would treat your son very similar to the urologist who was taking care of him initially. Your son should have periodic evaluation of his renal function, laboratory values and bladder evaluation. Vesicoureteral reflux and bladder dysfunction are both common in this group of patients. It sound like your son has both and needs to have these two aspect of his care evaluated. I'm not an acupuncturist nor am I a Homeopathic doctor. I speak from the discipline of traditional medical judgement.
The management of a child with posterior urethral valves depends on the degree of renal insufficiency which I do not have any way to assess in your son, and the age. Older children who have voiding dysfunction, which it sounds like your son has, and infections with reasonable renal function, can be observed with periodic check-ups. Decisions about reflux and bladder dysfunction are made on an individual basis.
The prognosis for children with urethral valves is improving. Current management allows for a low death rate, early infection control with appropriate and selective surgical options. It would be important for your son to have a modern urologic evaluation in an effort to take advantage of all that has been learned in the last few years. If nothing else your son deserves to know where his renal fuction stands and be educated on what to expect. Also the modern practice of nephrologic management with dialysis and renal transplantation has improved. My recommendation would be to see the urologic specialist and listen to what he or she has to say. Once you have that information, you can make an informed decision.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword: Posterior urethral valves
.
