British Journd o / Urology (1992), 70, 326-334 8 1992 British lournal of Urology
Case Reports Unusual Presentation of Adult Posterior Urethral Valve R.KAPOOR,A.TEWARl andV. K. MISHRA, Departmentof Urology, Sanjay Gandhi Post- Graduate Institute of Medical Sciences, L uckno w, India
A case of adult posterior urethral valve presenting with recurrent gravelluria and multiple urethral and ureteric calculi is reported.
Case Report A 27-year-old male presented with a 5-year history of recurrent urinary tract infection, gravelluria and straining during micturition. Serum creatinine was normal. The urine contained red blood cells, 20-30 pus cells/hpf and Escherichiu coli. Plain X-ray revealed bilateral lower ureteric calculi and a bunch of stones within the prostatic urethra. Micturating cystourethrography revealed a dilated prostatic urethra and no evidence of vesicoureteric reflux (Fig. 1). A
Fig. 2
retrograde urethrogram showed multiple radiolucent defects in the prostatic urethra (Fig. 2). Cystourethroscopy demonstrated multiple sago-like stones enmeshed in matrix in the dilated prostatic urethra. They were washed away without difficulty. Endoscopy revealed thick cusped type I posterior urethral valves which were retaining the stone mass. The posterior urethral valve was fulgurated and the ureteric stones were removed endoscopically at a later date. Post-operative recovery was uneventful. Follow-up 16 months later revealed a mean flow rate of 17 ml/s with complete emptying of the bladder, and reduced dilatation of the prostatic urethra.
Comment Adult posterior urethral valves are rare and patients usually present with bilateral hydronephrosis and renal failure (Marsden, 1969; Martin et al., 1977). Occasionally they may present with incontinence or a dilated Cowper’s gland (Drouin et al., 1979).
References Drouin, G., Laperriere, J. and Gregoire, A. (1979). Urethral valves as a cause of dilated Cowper’s glands and perineal pain. J. Urol., 120,634-635. Marsden, R. T. H. (1969). Posterior urethral valves in adults. Br. J. Urol., 41,586-591. Martin, J., Anderson, J. and Raz, S. (1977). Posterior urethral valves in adults: a report of 2 cases. J. Urol., 118,978-979. Requests for reprints to: R. Kapoor, Department of Urology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, P.B. 375, Raebareli Road, Lucknow 226 001, India.
Fig. 1
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Case Reports Unusual Presentation of Adult Posterior Urethral Valve R.KAPOOR,A.TEWARl andV. K. MISHRA, Departmentof Urology, Sanjay Gandhi Post- Graduate Institute of Medical Sciences, L uckno w, India
A case of adult posterior urethral valve presenting with recurrent gravelluria and multiple urethral and ureteric calculi is reported.
Case Report A 27-year-old male presented with a 5-year history of recurrent urinary tract infection, gravelluria and straining during micturition. Serum creatinine was normal. The urine contained red blood cells, 20-30 pus cells/hpf and Escherichiu coli. Plain X-ray revealed bilateral lower ureteric calculi and a bunch of stones within the prostatic urethra. Micturating cystourethrography revealed a dilated prostatic urethra and no evidence of vesicoureteric reflux (Fig. 1). A
Fig. 2
retrograde urethrogram showed multiple radiolucent defects in the prostatic urethra (Fig. 2). Cystourethroscopy demonstrated multiple sago-like stones enmeshed in matrix in the dilated prostatic urethra. They were washed away without difficulty. Endoscopy revealed thick cusped type I posterior urethral valves which were retaining the stone mass. The posterior urethral valve was fulgurated and the ureteric stones were removed endoscopically at a later date. Post-operative recovery was uneventful. Follow-up 16 months later revealed a mean flow rate of 17 ml/s with complete emptying of the bladder, and reduced dilatation of the prostatic urethra.
Comment Adult posterior urethral valves are rare and patients usually present with bilateral hydronephrosis and renal failure (Marsden, 1969; Martin et al., 1977). Occasionally they may present with incontinence or a dilated Cowper’s gland (Drouin et al., 1979).
References Drouin, G., Laperriere, J. and Gregoire, A. (1979). Urethral valves as a cause of dilated Cowper’s glands and perineal pain. J. Urol., 120,634-635. Marsden, R. T. H. (1969). Posterior urethral valves in adults. Br. J. Urol., 41,586-591. Martin, J., Anderson, J. and Raz, S. (1977). Posterior urethral valves in adults: a report of 2 cases. J. Urol., 118,978-979. Requests for reprints to: R. Kapoor, Department of Urology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, P.B. 375, Raebareli Road, Lucknow 226 001, India.
Fig. 1
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