Long-term results of primary avulsion of posterior urethral valves using a Fogarty balloon catheter

Abstract

Purpose: Posterior urethral valves are the most common cause of bladder outlet obstruction in infancy and cause renal failure in 25% to 30% of these children before adolescence. Transurethral ablation under direct vision is the most commonly used method of treatment for posterior urethral valves. Since 1987 we have used a Fogarty balloon catheter for primary avulsion of the posterior urethral valves in our patients. We evaluate the long-term results of this technique.

Materials and methods: During 14 years (1987 to 2001) 35 consecutive patients with posterior urethral valves underwent primary valve avulsion using a Fogarty balloon catheter. In 21 patients diagnosis was made prenatally, while the remaining 14 patients (6 newborns and 8 children with median age of 6 months) presented with urinary tract infection and renal failure. Vesicoureteral reflux was present in 22 (63%) of the 35 patients involving 34 renal units. Primary valve avulsion was performed using a 4Fr Fogarty balloon catheter under fluoroscopic control in all patients. Postoperative voiding cystourethrography was done 2 weeks after valve avulsion.

Results: None of the patients demonstrated any evidence of periurethral extravasation during the procedure. Postoperative voiding cystourethrography showed effective relief of valvular obstruction and good urethral drainage in 34 patients. In the remaining patient residual valve required transurethral ablation under direct vision. Vesicoureteral reflux resolved spontaneously in 12 of the 22 (54%) patients (20 renal units) and after an antireflux procedure in 4 (7 units). Two patients (3 renal units) are on antibiotic prophylaxis and 4 underwent nephroureterectomy for nonfunctioning dysplastic kidneys. At followup (1 to 14 years) all patients demonstrated a good urinary stream with no evidence of urethral stricture. Renal function did not improve in 5 (14%) of the 35 patients, 1 of whom has already undergone renal transplantation and another is awaiting transplantation.

Conclusions: Fogarty balloon catheter technique is a simple, safe and effective alternative to primary endoscopic transurethral ablation of posterior urethral valves.