The prognosis of posterior urethral valves, associated to vesicoureteral reflux in children.

Posterior urethral valves represent a congenital barrier at the level of the posterior urethra, which opposes miction. They are located near the prostatic urethra, originating at the verumontanum level, affecting male patients. The ureters are inconstantly dilated; vesicoureteral reflux is met in 2/3 of the cases. The reflux can be secondary to the sub-bladder barrier, but it can also be considered primitive, determined by the intra bladder ectopy of the ureter. The presence of the reflux is interpreted as a severe associated factor. Semiology is rather unusual, positive diagnosis is based on early discovery or antenatally of the impairment, by fetal echography starting from the 28th week of pregnancy, postnatal echography followed by miction cystography, retrograde urethrography and creatinine dosage complete the diagnosis. The treatment is surgical: endoscopic ablation of the valves (in the absence of renal failure), percutaneous pyelostomy, high lateral ureterostomy, and in severe cases vesicostomy and renal transplant. Prognosis depends on how early the impairment is detected, on the degree of pulmonary hypoplasia, on the presence of the vesicoureteral reflux and the possibility of recovering renal function; 1/3 of the newborns develop in time Chronic Renal Failure which requires renal transplant. The studied group comprised male children diagnosed with vesicoureteral reflux their ages ranking between 0 -18 years, admitted to the Pediatric Clinic, Tg. Mures during the last 10 years and children diagnosed and operated with posterior urethra valves at the Surgical Clinic of the "M. S. Curie" Hospital, Bucharest during the last 20 years. Our results show that out of the total number of studied children 25 presented posterior urethra valves and 9 children presented vesicoureteral reflux. We can conclude that the presence of the vesicoureteral reflux is an unfavorable prognosis regarding the degree of renal failure.