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Journal of Paediatric Surgeons of Bangladesh
Original Articles · Vol. 2 No. 2 (2011)

Outcome of Vesiciureteric Reflux After Primary Fulguration of Posterior Urethral Valves

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JPSB
Journal of
Paediatric Surgeons of Bangladesh
Published : July 2011
CONTENTSVolume 02Number 2July 2011
Editorial
Laparoscopy in Children, A Brief Outline and Bangladesh Perspective
Md. Jafrul Hannan
42
Original Articles
Outcome of Vesiciureteric Reflux After Primary Fulguration of Posterior Urethral Valves
M. M. Masud Pervez, Kaniz Hasina, Md. Ashraf Ul Huq, Md. Nooruzzaman, Abdul Hanif
46
Post A-H Pyeloplasty Analysis of Renal Function in Unilateral Hydronephrosis Due to Congenital Pelviureteric Junction Obstruction
Nandan Kumar Majumder, Md. Ruhul Amin, Rajib Khastgir, Mizanur Rahman, Md. Abu Bakar Akan
53
Assesment of The Effect of Multimodal Preemptive Analgesia in Children
Md. Nooruzzaman, MM Masud Pervez, Md. Abu Bakar Akan, M Anisuzzaman, Md. Nazrul Islam, AM Shahinoor
56
Early Post-operative Outcome of Primary Repair of Bladder Exstrophy With or Without Osteotomy
S. M. Borhan Uddin, Md. Abu Bakar Akan, Rajib Khastgir, Md. Ruhul Amin
63
Evaluation of Congenital Upper Urinary Tract Anomalies in Hypospadias
Md. Abdullah Al Farooq, Shafiqul Hoque
68
Decreased Morbidity and Mortality from Intestinal Ascariasis: Experience of a Single Center
Md. Akbar Hossain Bhuyian, Md. Abdullah Al Farooq, Md. Minhajuddin Sajid, MA Mushfiqur Rahman, Md. Momtazul Hoque, Khurshid Alam Sarwar, Tanvir Kabir Chowdhury, Mahfuzul Kabir, Tahmina Banu
73
Case Reports
Desmoplastic Small Round Cell Tumour (DSRCT) - A Case Report and Review of Literature
AKM Amirul Morshed, Farhana Afroz, Chowdhury Md. Fuad Galib, Shahnoor Islam, Kaniz Hasina, Ashish Kumar Ghosh
79
Spontaneous Common Bile Duct Perforation on The Background of Pancreatic Lithiasis: A Case Report and The Review of The Literatures
Md. Abdullah Al Farooq, M A Mushfiqur Rahman, Mahfuzul Kabir, Md. Akbar Husain Bhuiyan, Md. Minhajuddin Sajid, Rupam Talukder, Tanvir Kabir Chowdhury, Tahmina Banu
83
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ASSOCIATION OF PAEDIATRIC SURGEONS OF BANGLADESH (APSB)
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Authors

  • M. M. Masud PervezDepartment of Urology, BIRDEM Hospital, Dhaka
  • Kaniz HasinaDepartment of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Md. Ashraf Ul HuqDepartment of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Md. NooruzzamanMedical Officer (OSD), DGHS, Dhaka
  • Abdul HanifDepartment of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka

Keywords

Posterior urethral valves (PUV) Vesicoureteric reflux (VUR) Cystoscopic fulguration

Abstract

Introduction: Congenital obstruction of the urethra is one of the most devastating anomalies to occur in the urinary tract and one of the few that are life-threatening in the neonatal period. Posterior urethral valve (PUV) is the most frequent cause of urethral obstruction in male child. These lesions usually result in lifelong disabilities with incontinence and decreased renal function despite optimal medical management. Primary fulguration without upper tract diversion is the preferred modality of treatment in most cases of PUV. Regular follow-up is needed to check completion of valve fulguration, renal function, status of hydronephrosis, vesicoureteric reflux (VUR), urinary tract infection (UTI), and bladder function. Materials and methods: We conducted interventional study among 30 purposively selected patients of PUV in the Department of Pediatric surgery, Dhaka Medical College Hospital (DMCH), Dhaka, over a period of 16 months from December 2009 to March 2011. Age of study subjects varied from 2 days to 14 years. Among the 30 patients, 16 were children in the age group between 1 year to 14 years (53.3%), 11 (36.7%) were infants and the rest 03 (10%) were neonates. Most of the patients presented with weak urinary stream, dribbling of urine, straining at micturition, UTI and palpable bladder. All children were subjected to ultrasonography (USG), blood urea, serum creatinine, routine urine examination and culture studies. Structured questionnaire was used to collect information regarding improvement of VUR and renal functional status before & after primary fulguration of PUV. Results: Average serum creatinine level was found gradually decreased in subsequent follow up in comparison with the previous one. This difference of creatinine level was found statistically significant in t test (p<0.01). Average blood urea nitrogen (BUN) was also decreased which was found statistically significant (p<0.05). VUR was present in 63.3% cases. Non- VUR was found in 60% cases on right side and 50% cases on left side. On the third follow-up after 3 months it became 73.3% on right side and 63.3% on left side. Positive correlation found in Pearson correlation test about the changes of reflux grades before and after fulguration was significant at the level of 0.01 (p<0.001). It was significant on both left and right kidneys. Positive correlation found in Pearson correlation test about the changes of GFR before and after fulguration was also significant at the level of 0.01 (p<0.001). Collected data was cleaned, edited and analyzed with the help of software SPSS window version 15.0. Conclusion: In this study, VUR disappeared in some cases and decreased in majority of the cases by 3 months after adequate restoration of urethral patency. Renal function came to normal range in two thirds of the cases.

Journal of Paediatric Surgeons of Bangladesh (2011) Vol. 2 (2): 46–52

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