Posterior urethral valves (PUV) are considered the most common cause of infravesical obstruction in boys, while anterior urethral valves (AUV) are less commonly encountered. Concomitant AUV and PUV has been reported to be uncommon, so it may be missed during the initial evaluation. Herein, we demonstrate a video-case illustrating a step-by-step surgical management of concomitant AUV and PUV.

This video shows the diagnostic and surgical approach for a 2-day old boy who was presented with poor urine stream, bilateral antenatal hydronephrosis and high serum creatinine (2.1 mg/dl). He underwent renal and bladder ultrasonography (RBUS) that showed bilateral grade IIa hydronephrosis with dilated upper and lower ends of both ureters and thick-walled urinary bladder with minimal amount of urine inside. Voiding cystourethrogram (VCUG) was ordered and showed right GV vesicoureteral reflux (VUR), highly positioned urinary bladder, dilated both anterior and posterior portions of the urethra. Cystoscopy was done and revealed leaflets of PUV at 5,7 and 12 O'clock, AUV at 6 O'clock, hypertrophied bladder neck and trabeculated bladder mucosa. Endoscopic valve ablation using wolffian knife was done at 7, 5, 6 and 12 O'clock, respectively, followed by bladder neck incision at 6 O'clock.

At the end of the procedure, patent urethra was noted with no evidence of any residual obstruction. By manual compression on the urinary bladder, good flow of urine was observed. The urethral catheter was kept indwelling for 2 days, and after removal of the urethral catheter, the patient voided well. Serum creatinine dropped to 1.3 mg/dl. No fever or abdominal distention was encountered.

Association of AUV and PUV is uncommon but it occurs, so it should not be missed during radiological and cystoscopic evaluation.

Continence 7S1 (2023) 100786
DOI: 10.1016/j.cont.2023.100786