The importance of re-look urethrocystoscopy after fulguration of posterior urethral valve

Mahmudul Hasan; Khandaker Mahadiul Haque; Kanij Fatema; Mohammad Abdur Rahman; M. Masud Rana Badol; Abdullah Al Mamun; Isteaq Ahmed Shameem

doi:10.18203/2349-2902.isj20251160

Authors

Mahmudul Hasan Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Khandaker Mahadiul Haque Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Kanij Fatema District Sadar Hospital, Rajbari, Bangladesh
Mohammad Abdur Rahman Upazila Health Office, Sadar, Rajbari, Bangladesh https://orcid.org/0009-0007-8437-0779
M. Masud Rana Badol Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Abdullah Al Mamun Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Isteaq Ahmed Shameem Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-2902.isj20251160

Keywords:

Endoscopic fulguration, Posterior urethral valve, Re-look urethrocystoscopy, Voiding cystourethrograms

Abstract

Background: Endoscopic fulguration is the gold-standard treatment for posterior urethral valve (PUV). However, there is no consensus on detecting residual valves post-fulguration. Some urologists advocate re-look urethrocystoscopy (UC), while others recommend voiding cystourethrograms (VCUG). This study evaluates the significance of re-look UC after initial PUV fulguration.

Methods: This observational study involved 28 patients undergoing re-look UC post-fulguration due to persistent symptoms, elevated serum creatinine, or abnormalities in uroflowmetry and ultrasonography (e.g., high post-void residual (PVR) or hydroureteronephrosis). Continuous data were analyzed using the Wilcoxon signed-rank test and categorical data with Fischer’s exact test, with p<0.05 deemed significant.

Results: The median age for re-look UC was 7 years. Symptoms included weak urinary stream (92.9%), straining (75%), dribbling (71.4%), and others. Hydroureteronephrosis was noted in 92.9% of cases, and 50% had elevated serum creatinine. Residual valves were detected in 21.4% of patients three months after initial fulguration. Residual PUV was associated with a higher median age of 10 years (p=0.045). No significant associations were found between residual PUV and hydroureteronephrosis, PVR, or serum creatinine levels.

Conclusions: Re-look UC is crucial for detecting residual valves, enhancing clinical outcomes, and improving long-term bladder function. Integrating re-look UC into PUV management protocols is recommended to ensure comprehensive patient care.

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