I. EPIDEMIOLOGIC FACTORS
AGE:
The mean age at diagnosis of all the 28 patients was 2.9 years
(range 9 days to 13 years ) which is significantly higher than that reported by
COULIBALY, 2 years (18). In a series of 100 cases reported by SMITH et al (31),
42% of PUV were diagnosed before 1 month, and 56% before 1 year. In our series
50% of PUV were diagnosed after 12 months. The mean age at diagnosis in the
series reported by WARSHAW et al (38) was 39 days.
The mean age of the first consultation after onset of symptoms
was 1.6 years (range 1 day to 8 years). The mean interval between age of first
consultation and age of diagnosis was 9.7 months which is still higher than 51
days, reported by COULIBALY et al in Côte d'Ivoire (18). The mean number
of follow-ups was 3 (range 0 to 10)
We decided to divide our patients into 3 groups (see Table 1)
because it is believed that chronological age at presentation is a relatively
well -defined marker for delineating severity (14).
PAST HISTORY (Table 2):
UTI was noted in 50% of our patients. LOTTMAN (52)
noted it in 64 % of his cases, ATWEL (4) in 34% and COULIBALY (18) in 85%
of their cases. Hypertension was noted in 2 patients (7%) who presented with
end-stage renal failure. In 1 patient there was a family history of renal
disease. The cousin had end -stage renal failure from PUV, underwent kidney
transplant and is currently undergoing hemodialysis.
PRESENTING COMPLAINTS (Table 3):
In our series an abnormal urinary stream with dribbling was
most frequent in 60.7% of the patients, followed by dysuria. ANGWAFO et al (5)
noted in 100% of their patients. ATWEL (4) noted in 17% and LOTTMAN (52) in
(32%). Dysuria was the second most frequent complaint (54%) but was the most
frequent (46%) in COULIBALY's series (18). Most mothers don't know the
characteristics of a normal
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POSTERIOR URETHRAL VALVES IN CHILDREN: A review of 28
cases in Yaounde
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urinary stream, so it should be well described when seeking to
know about the presence or absence of dribbling. Two patients with end-stage
chronic failure were observed in our series.
One had undergone kidney transplant in France. Of the
non-urinary symptoms fever (25%) and failure to thrive (25%) were most
frequent. COULIBALY et al (18) noted respectively 22% and 11%. 32% of the
non-urinary symptoms were digestive (vomiting, diarrhoea and dehydration)
MAIN PHYSICAL FINDINGS (Table 4):
Umbilical hernias were most observed ( 21 %). This finding is
very rare in literature but it was 68.2% in the series reported by ANGWAFO et
al (5). It should be noted that our series was much larger than that of ANGWAFO
et al. Bladder distention occurred in 69.8% in COULIBALY's series and was the
most frequent physical finding. Bladder distention was the second most frequent
finding in our patients. ISVD was noted in 2 patients and diagnosed in the
neonatal period. We noted the presence of trisomy 21 associated an IVSD. The
possible association of PUV and trisomy 21 has been reported by some authors
(39). It has been suggested that infants with trisomy 21 should be screened
with ultrasonography for renal and urological abnormalities early in life
because they have increased risk of developing PUV and obstructive uropathy.
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