POSTERIOR URETHRAL VALVES IN ADULT MALES R. J. OPSOMER, M.D. F. X. WESE, M.D. A. N. DARDENNE, M.D. P. J. VAN CANGH, M.D.

From the Divisions of Urology and Radiology, University of Louvain Medical School, Brussels, Belgium

ABSTRACT--We report on 2 cases of posterior urethral valves in young adult males referred for f#ihary and sexual symptoms.

~6~ferior urethral valves are a common cause of :anfravesmal obstruetmn a children and m the ! i i ~ o r n . Occasionally these valves remain si:}!i4~:'~:~::untiladulthood. We recently encountered 2 ~rP°;~:~g wU~"~hr a ] v 2 ~ eSnhnY x°u Z y du~! •

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VOLUME XXXVI, NUMBER 1

Case Reports Case 1 A twenty-seven-year-old man complaining of primary retrograde ejaculation and burning sensation in the urethra after sexual intercourse was referred for sexual counselling. Physical examination was noncontributory. Voiding eystourethrography demonstrated infravesieal obstruction at the level of the verumontanum (Fig. 1). Urodynamie evaluation (pressure flow study) confirmed infravesieal obstruction (Fig. 2A). Urethroscopy revealed Type 1 posterior urethral valves (Fig. 3). We performed an incision of the valves. Postoperative radiology demonstrated disappearance of the infravesieal obstruction although urodynamics displayed persistent detrusor instability and high pressure waves during micturition (Fig. 2B). One year postoperatively, retrograde ejaculation persists, but he has no postcoital painful sensations. Case 2 A twenty-two-year-old man was referred for recurrent urinary tract infections and perineal pain. Cystourethrography demonstrated a narrow segment at the level of the verumontanum (Fig. 4). Urethroseopy revealed the presence of valves. Pressure flow study was normal. He underwent transurethral incision of the valves (Fig. 5) and is now symptom-free. 35

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F'I(~URE 3. Case 1. Peroperative urethroscopy: ~'erumOntanum visualized behind leaves of valves.

FIGURE 5. Case 2. Peroperative urethroscopy shows valve raised by Collins knife. for years and m a y be disclosed in young adult males referred for urinary or sexual symptoms. Posterior urethral valves as a cause of retrog r a d e e j a c u l a t i o n h a v e b e e n r e p o r t e d by others. 2-4 Incision of valves is not effective in these patients since dilatation of the posterior urethra and bladder neck persists postoperatively. P h a r m a e o t h e r a p y m a y then be tried. Few eases of perineal pain and prostatitis-like s y m p t o m s s e c o n d a r y to p o s t e r i o r u r e t h r a l valves have been reported. 5 Symptoms usually d i s a p p e a r after endoscopic incision of the valves. Our two observations emphasize the need for thorough urologic and radiologie investigations in y o u n g adult males presenting c o m b i n e d urinary and sexual symptoms.

|'~i:[~!~:~E4. Case 2 Preoperative voiding cysi!O~'e~hrOgraphy i~[~i~i~'~t~J!~n~Oatanum,shows' narrow "segment at level of Comment tl valves were first described 17. Young et al. ~ gave an aeof endoscopic findings and ~'ation of valves into 3 types lay. Posterior urethral valves st c o m m o n etiologies of inon in newborns and children aized m a y lead to ureterohy~nal failure. However, w h e n a can be overcome by detruLe valves m a y remain silent .................

JULY 1990 / VOLUMEXXXVI,NUMBER1

Cliniques Universitaires St Luc UCL 10/1410 Division of Urology Avenue Hippoerate 10 B-1200 Brussels, Belgium (DR. OPSOMER) References 1. Young HH, Frontz WA, and Baldwin JC: Congenital obstruction of the posterior urethra, J Urol 3:289 (1919). 2. Fieldman NR, and Milroy EJG: Urethral valves in an adulL an unusual cause of retrograde ejaculation, Br J UroI 56:101 (1984). 3. WaligoraJ: Un easexceptionnel, mais exemplaire dest6rilit6 masculine curable par section d'une valve de l'ur6tre, J Urol (Paris) 86:243 (1980). 4. Paramo PG, Martinez-Pineiro JA, De La Pena JJ, and Paramo PS: Andrologieal implications of congenital posterior urethral valves in adults. A ease of retained ejaculation and review of Western literature, Eur Urol 9:359 (1983). 5. Drouin G, Laperri~re J, and Gr6goire A: Urethral valves as a cause of dilated Cowper's glands and perineal pain, J Urol 120: 634 (1978).

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