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Suggest Treatment For Posterior Urethra Valve

Posted on Mon, 21 Sep 2015

Question: my 31 year old son was diagnosed with posterior urethra valve and had ablation of the valve membrane. he has mild bladder thickness and normal kidney function. What concerns should we have and what is the long term outlook.

Answered by Dr. Dr. P. T. Patil (28 minutes later)

Brief Answer:
Need clarification about age of your son

Detailed Answer:
Hello
Thanks for query .

You have mentioned age of your son to be 31 years which needs to be corrected .Based on your statement your son has Posterior Urethral Valves which were fulgurated .

The mild thickening of the wall of the bladder is natural due to obstruction to outflow of urine .The bladder wall and muscle gets hypertrophied due to pressure it has to apply to overcome the obstruction caused to outflow of urine. This will gradually get corrected over a period of 6 months .

Since his kidney function is normal you need not worry at all ..You have to see that he does not get UTI and monitor his urine flow and get his scanning done every 6 months for 3-4 years.

Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (9 minutes later)

if he needed to have the ablation done again is that a concern. Also how did my son have this for 31 years and urinate until it became obstructed this past year. I guess I am asking how did he urinate prior to this. Did the membrane get thicker?

I reread your reply. My son is a 31 year od adult.

Answered by Dr. Dr. P. T. Patil (9 minutes later)

Brief Answer:
Read detail answer below .

Detailed Answer:
Hello.

Thanks for follow up and feedback
It is really surprising that your son has no urinary problem or outflow symptoms till the the age of 31 years (This is first time I am hearing in my 42 years of practice ).

Normally patient with Posterior Urethral Valve present with obstructive urinary symptoms in infancy or early childhood .

It is likely that he may have very thin valve and may not be obstructing urine flow .

He does not need any specific precaution but watch his urine flow .

Thanks and Regards.
Dr.Pati;l.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (9 minutes later)

I think all these years what he thought was normal was normal for him until urine just started leaking. Urologist said the valve kept getting smaller??? I found on the internet where it stated that 10% of PUV is found in adolescents and adults. Will my adult son's bladder return to normal? Will there be scarring from the ablation?

What does a thin valve mean?

Are you able to answer my additional concerns in reference to the mild thickness of my son's bladder and possible scarring from the ablation and if he needed to do this again is that a concern?

Dr. XXXXXXX

I would really like to know since my son is 31 and has a mild thickening of his bladder if this will correct itself or if not will this be a problem? Also if there is scarring from the ablation can this cause obstruction again? Is there a problem doing ablation again?

Answered by Dr. Dr. P. T. Patil (8 hours later)

Brief Answer:
He will not have any problem in future .

Detailed Answer:
Hello
Thanks for follow up.
The thickening of bladder wall will get regressed over a period of time and will not cause any problem in future.

As regards your fear of scarring at the site of fulguration of the valve .There is minimal thermal injury to the tissue during fulguration and rarely gets scarred that to only with extensive fulguration of valve which is unlikely in case of your son .

Do not worry he should not have any problem in future .
Thanks and Regards.
Dr.Patul.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

What is extensive fulguration? The doctor said at the time the hole was like a pin?
Sorry for all the questions except that my mind is just full of worry after learning what was wrong and searching on internet? Also, my friends brother is a urologist and said this usually has to be done again.

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Extensive fulguration is fulguration done for longer period of time .

Detailed Answer:
hello
Thanks for follow up.
It is likely he had very thin membrane which did not obstruct his urine flow significantly for 31 years making it to fulgurate for few seconds causing negligible thermal injury to result in to scarring ..

Please do not read too much on internet ,It will make you more confused rather than any help.

Thanks and Regards.
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (16 hours later)

Sorry about all the questions. I am a totally anxious person especially when it concerns the health of my children. I presented this question to a well known urologist in California, Dr. Gellman. His reply was that PUV occurs in infants and this was a stricture that would occur again. It almost sounded like he thinks the Doctor did not diagnose correctly. Do you believe that this is PUV in an adult male.?

Answered by Dr. Dr. P. T. Patil (4 hours later)

Brief Answer:
Read my earlier answers

Detailed Answer:
Hello
Thanks for follow up .If you go through my answers earlier I have stated that I have not seen a case of PUV in a adult in 42 years of my practice ,but I had to believe in what you have posted in your query .

It is likely that it may be a stricture rather than a P U Valve as rightly said by Dr.Gellman .

This confusion could have been avoided if you would have uploaded Ultrasound Scanning report.

The stricture urethra has tendency to recur but can be managed with Visual Internal Urethrotomy.(VIU).

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (7 days later)

some additional questions to help alleviate some of the anxiety about my 31 year old son. My son was the 31 year old diagnosed with posterior urethral valve obstruction and had ablation. From what I read 10% of the cases are in the adult population. My additional question is will his mildly thickened bladder return to normal and will there be scar tissue from the ablation that could cause an obstruction again..

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
Thickening of bladder will regress gradually .

Detailed Answer:
Hello
Thanks for follow up.The mild thickening of the bladder wall will regress gradually .

The incidence of scarring after ablation are very rare .Hence you should not to worry about the obstruction again .
Thanks and Regards.
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Is this the answer to the congenital stricture? Also what is a congenital stricture?
Thanks

Answered by Dr. Dr. P. T. Patil (7 hours later)

Brief Answer:
Answer is pertaining to Posterior Urethral Valve you nave mentioned about.

Detailed Answer:
Hello
Thanks for follow up .The answer I have given on your query is about Posterior Urethral Valve and not structure .

As such congenital stricture of urethra will not have it's manifestations so late at the age of 31 years.

Congenital stricture is narrowing of urethra which is noticed and detected due to obstructive voiding urinary symptoms in infancy or early childhood.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

I am so confused. I went with my son to the doctor and I said I am been reading about puv and wanted to ask him some questions. The dr. said my son did not have puv but a congenital stricture. How do we know exactly what his obstruction was?

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
Since it is already ablated can not ascertain the nature of obsturction .

Detailed Answer:
Hello
Thanks for follow up.
Since it is already ablated it is not possible to ascertain now whether it was PU valve or a Stricture .

I would suggest you not to read too much on internet .It will add to your confusion more than helping you .
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (5 hours later)

I feel it is very important to know. I have the picture of what the doctor did. Looking at the pictures can a doctor determine it was a valve or stricture. I can also get the medical records. Wouldn't knowing that it is a valve or stricture let us know the tendency of it recurring.

Answered by Dr. Dr. P. T. Patil (7 minutes later)

Brief Answer:
You have to consult Urologist for clarification

Detailed Answer:
Hello
Thanks for follow up .
It is very difficult to make comments on finding and diagnosis of some one else.I have opined based on the facts that you have posted .It will be better if you consult the Urologist who has operated him for clarification as regards diagnosis whether it was stricture or Posterior Urethral Valve .

By the way stricture has tendency to recur whereas valves once ablated does not recur.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (44 minutes later)

the doctor would not tell me. Now I having extreme anxiety. On our visit after the procedures the doctor said it was a valve. On our 6 month visit when I said I have been reading posterior valve he said it wasn't that and it was even more rare and it was congenital. He just acted like I need not need to know. I am thinking maybe it was anterior uthreal valve. In the mean time I am not handling this well and experiencing extreme anxiety. I cant let go of this.

Answered by Dr. Dr. P. T. Patil (5 minutes later)

Brief Answer:
Take second opinion of Urologist in your area.

Detailed Answer:
Hello
Thanks for follow up .I can understand your anxiety and concern about your son .

I would suggest to consult other Urologist in your vicinity with reports and picture that you have for second opinion .He may do endoscopic examination (Cystoscopy) of your son and will be a proper person to allay your anxiety and clarify your doubts .

Thanks and Regards,
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

thank you. I am going to take medical records and pictures to another urologist for opinion. Can you just answer this last question. Can anterior urethral valve be undetected until adulthood. Doe anterior valve tend to come back again?
Deeply thankful

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer:
I have not come across a single case of Anterior Urethral Valve .

Detailed Answer:
Hello
Thanks for follow up .
I have not seen a single case of anterior urethral valve in my 43 years of practice hence will not able to comment on your query..
Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar