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IntroductionA Urethral diverticulum can be defined as sac-like dilation lined with epithelial tissue, which may be congenital or acquired. It usually develops in the penoscrotal angle region but can also be observed in the penile urethra. It usually occurs in female teenagers. This report aims to discuss a male infant with a large urethral diverticulum.Case presentationA 5-month-old male presented to the urological department at Sulaimani Teaching Hospital with a penile swelling that had been noticeable since birth. Clinical examination revealed a ventral cystic penile shaft swelling, which would fill with fluid during urination. A urethrocystoscopy was performed and showed a wide cystic ventral diverticulum. Diverticulectomy was performed as a surgical approach to remove the diverticulum.DiscussionCongenital anterior urethral diverticulum is an uncommon condition that typically begins in early life. It can manifest with various symptoms, like recurrent infections of the urinary tract, painful urination, and post-void urine dribbling. Diagnosis involves imaging, with urethrocystoscopy, to rule out other potential diagnoses. Different surgical techniques exist that show promising results in preventing recurrence. The current case involved diverticulectomy and multi-layered wound closure with a dartos flap.ConclusionLarge anterior diverticulum in early infancy is rare but possible; operation is the preferred intervention method.

Objective: This case report will present transurethral resection of double anterior urethral valves in tertiary hospital. Case(s) Presentation: A three-year-old boy who complained of a poor stream of urine and discomfort during micturition. From the radiological examination, the main finding was found on ultrasound (USG), with thickening of the bladder wall without upper tract abnormality. On panendoscopy, we found double anterior urethral valves at bulbar part and trabeculation in bladder. Discussion: The resection of the valves was performed and achieved an excellent result included normal stream of urine and there was no discomfort during micturition. Conclusion: Anterior Urethral Valve is a rare case that can be caused a lower urinary tract obstruction. A good understanding of AUV’s radiological and endoscopic anatomy is required to differentiate it from other diseases, essential to prevent further injury, and also to decide for appropriate management. Keywords: Anterior Urethral Valve, Congenital Anomaly, Urinary Obstruction

The anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children; they are much rarer than posterior urethral valves. A 13-year-old male presented with obstructive and irritative lower urinary tract symptoms (LUTS). On urethrocystoscopy, an AUV with a diverticulum was noted in the ventral surface of the urethra. It was ablated endoscopically using the holmium laser. Postoperatively, the patient voided successfully without any immediate complications. AUV with diverticulum may occur in adolescents. Endoscopic holmium laser ablation of the valve and the diverticulum is associated with good outcome. [ABSTRACT FROM AUTHOR]

• Visible swelling within the ventral part of penis during micturation should suggest possibility of an anterior urethral valve (AUV) and urethral diverticulum. • Voiding cystourethrography and cystoscopy are the preferred diagnostic investigations. • Urinary obstruction, renal dysfunction and urosepsis are possible consequences of AUVs. Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. The present study highlights the clinical approach in identifying the condition and its treatment options. Single centre, retrospective study of children. Over a 16 year duration, 14 children were diagnosed with AUVs and diverticula with a mean age of 15 months. Clinical features included straining at micturation and a palpable penile swelling. Diagnosis was confirmed with voiding cystourethrogram and cystoscopy. An open surgical procedure was performed in 12 cases and endoscopic intervention done in one. On follow up 13 patients showed restoration of a normal voiding stream and normal renal function. One child died of chronic renal failure due to a delayed presentation, severe back-pressure changes, urinary ascites, and urosepsis. One patient developed a small urethrocutaneous fistula that healed spontaneously. AUV, though rare, should be recognizable due to the combination of a poor urinary stream and visible swelling in the ventral aspect of penis. Open surgical excision is the method of choice, and the outcome is excellent. Level IV. [ABSTRACT FROM AUTHOR]

The deformation of congenital obstruction of the anterior urethra is rare in male infants. The anterior urethral valve (AUV) and diverticulum are not common causes of distal urethral obstruction, which may be significant but difficult to diagnose in time. We describe a premature infant who was diagnosed with AUV as part of a diverticulum in the anterior urethra and was presented as massive urinary ascites without hydroureters and hydronephrosis. After indwelling abdominal tube and urinary catheterization, the infant’s massive ascites were resolved, while urethral obstruction had successful treatment by Holmium laser. We suggest that the presence of urinary ascites in fetuses and neonates should be considered as a warning against urinary malformations.

The article presents answers related to the possible diagnosis of a rare representation of voiding difficulty in an adolescent, including his possible diagnosis of anterior urethral valve (AUV), the diagnostic tool of cystoscopy, and treatment of transurethral valve ablation.

Anterior urethral valve (AUV) is a rare but well-defined congenital anomaly. AUV can be isolated or occur in association with anterior urethral diverticulum (AUD). Here, we present the first pediatric case report of AUV and AUD which is complicated with an intradiverticular stone. We also review the literature involving AUV with AUD cases.

Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly.

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

Congenital anterior urethral diverticulum is a very rare cause of lower urinary tract obstruction. It usually occurs at the penoscrotal junction but also may occur at the penile urethra. Two months old male baby presented with soft cystic swelling at the anterior urethra ballooning during micturition. Diagnosis was confirmed by MCUG and ultrasonography. Open diverticulectomy was done. [ABSTRACT FROM AUTHOR]

Anterior urethral valve (AUV) is a rare but well-defined congenital anomaly. AUV can be isolated or occur in association with anterior urethral diverticulum (AUD). Here, we present the first pediatric case report of AUV and AUD which is complicated with an intradiverticular stone. We also review the literature involving AUV with AUD cases. [ABSTRACT FROM AUTHOR]

Anterior urethral valve (AUV) is a long known but rare anomaly, which is occasionally encountered in boys with obstructive uropathy. We present a case of AUV with a diverticulum which was misdiagnosed at other center as neurogenic bladder resulting in chronic renal failure. The case was further complicated by breakage of tip of the catheter used for clean intermittent catheterization (CIC) in the diverticulum presenting as a foreign body in the urethra. This article highlights the frequently missed diagnosis of AUV by most practitioners wrongly labeling it as neurogenic bladder, leading to improper management and renal failure in young boys.

Objective To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves. Methods We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded. Results From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients. Conclusions Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-year-old mother who was admitted to the Tokyo University Hospital for 31 weeks of pregnancy because of oligohydramnios. Fetal sonography revealed a left perinephic urinoma, megacystis, bilateral hydronephrosis, and hydroureter in the fetus. Low urinary tract obstruction was also suspected. At the 33rd week, a male infant was delivered weighing 2369 grams with neonatal asphyxia. The mother managed with prenatal urinary ascites evacuation.

Congenital anomalies of the urogenital tract are the most common anomalies found in the foetus, neonates and infants, but anterior urethral valves and diverticula are rare. Here, we present a case with congenital anterior urethral diverticulum associated with patent ductus arteriosus and polydactyly. [ABSTRACT FROM AUTHOR]

Introduction: Anterior urethral valves (AUVs) are uncommon congenital anomalies causing urethral obstruction in boys.Patients and Methods: Medical records of 13 children were reviewed retrospectively. Each patient (pt) was evaluated with voiding cysto-urethrogram (VCUG) and renal ultrasonography. Pts older than 5 years performed an uroflowmetry. Serum creatine was determined in all children.Results: All pts had difficulty in voiding and eight had recurrent urinary tract infection. Renal function was normal in all pts. VCUG showed filling of Cowper's duct in a pt. In a case, a vesicoureteral reflux was discovered. Uroflowmetry showed a flat trace in all cases. Transurethral endoscopic resection of the valves was carried out in 11 children while open resection was necessary in two children. At serial follow-up, all pts remain symptom-free and uroflowmetry documented regular pattern.Discussion: Anterior urethral valves are rare lesions that may create problems at different stages. Some AUVs may result from the obstruction distal lip of a ruptured syringocele. Improvements in endoscopic equipment allow for minimally invasive transurethral resection. Large diverticula are best managed with open diverticulectomy and reconstruction. In newborns with severe altered urinary tract drainage, particularly in low birth-weight infant, a vesicostomy may be necessary. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Anterior urethral valves (AUV) are rare entities generally described in case reports. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. In the present study, we present our experience in four children with AUV along with a literature review. Materials and methods: We retrospectively identified four children with AUV presented between 1998 and 2005 at age 4–9 years. Results: Hematuria, urinary tract infection and weak voiding stream were the most common symptoms. Voiding cystourethrography (VCUG) confirmed the diagnosis of AUV. On cystourethroscopy, cusp-like valves in the anterior urethra were seen in all children. Transurethral endoscopic resection of the valves was carried out in three children using a pediatric resectoscope. In one child with a massive anterior urethral diverticulum, open resection of the valve, diverticulectomy and urethroplasty were performed. All patients were cured, none had complications as a result of surgery, and all reported a normal urinary stream at follow-up. Conclusions: Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valves should be considered in differential diagnosis of obstructive lesions. [Copyright &y& Elsevier]

The experience from Boston in anterior urethral valves and diverticula over a 40-year period is described. Other articles describe experience with both ignoring and treating VUR, and ballooning of the foreskin and physiological phimosis. To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity. Nine cases (all boys; 1963 to 2003) were reviewed retrospectively. Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice. This series indicates that the distal lip of a ruptured syringocele may function as a flap-valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity. [ABSTRACT FROM AUTHOR]

Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. [ABSTRACT FROM AUTHOR]

Two unusual cases of anterior urethral valves ( AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification. [ABSTRACT FROM AUTHOR]

Anterior urethral valve (AUV) is a rare congenital anomaly that can lead to severe obstructive uropathy. Early diagnosis and management of AUV is very important to prevent further damage due to vesicoureteral reflux and infection. We present a neonate with febrile urinary tract infection and ultrasonography revealed hydronephrotic left kidney with a distended urinary bladder. Voiding cystourethrogram (VCUG) initially missed an AUV which was picked up on cystourethroscopy. When VCUG was examined again, an AUV without dilatation in the urethra was seen. Transurethral valve ablation was done. [ABSTRACT FROM AUTHOR]

The article describes the case of a 10-year-old boy who was diagnosed with type 1 posterior urethral valves. There was neither a palpable abdominal mass nor lumbosacral abnormality on physical examination. Abdominal ultrasonography showed bladder wall thickening and bladder diverticulum without hydronephrosis. The patient was encouraged to undergo voiding cystourethrography that was performed using an 8 Fr urethral catheter.

Anterior urethral valve (AUV) and anterior urethral diverticulum (AUD) are two rare causes of anterior urethral obstruction with variable presentation and anatomy. Their existence as the same or different entity is still debatable, and management has not yet been standardized. This study is a retrospective review of cases diagnosed with anterior urethral obstruction and correlation of radiological and endoscopic anatomy of AUV and AUD. A retrospective review of cases diagnosed with AUV and AUD, between May 2013 and February 2020 is presented. The presentation, laboratory, radiological and endoscopic anatomy along with the management required was reviewed. A special emphasis has been given on the correlation of radiological and endoscopic anatomy and an attempt has been made to standardize the management. A total of 8 patients with age ranging from 2 months to 9 years were reviewed. Poor urinary stream and recurrent UTI was the commonest presentation. The anatomy of the anterior urethra on VCUG (voiding cystourethrogram) and Urethrocystoscopy was correlated. Two sets of patients were identified. In the first set, five cases on endoscopy had findings of the classical valve-like fold in the anterior urethra with immediate proximal dilation of the urethra giving the appearance of a 'pseudodiverticula' without any definite opening. In three of these cases, endoscopic findings correlated well with radiological findings of 'pseudodiverticula' in which dilated proximal urethra formed an obtuse angle with the ventral floor of the urethra. The other set of four patients had a 'true diverticula' on endoscopy with a well-defined mouth and prominent distal lip, correlating well with radiological findings of a 'true diverticula' forming an acute angle with the ventral floor of the urethra. One case on endoscopy had both an anterior urethral valve with a proximal 'pseudodiverticula and a large wide-mouthed bulbar 'true diverticula'. All the patients with classical valves were successfully treated using a resectoscope while two patients with 'true diverticula' were successfully managed by incising the distal lip. One of the patients previously managed for the posterior urethral valve (PUV) had both classical valves in the anterior urethra with proximal 'pseudodiverticula' and a bulbar 'true diverticula'. The AUV was ablated with a resectoscope while 'true diverticula' required diverticulectomy. All the patients after follow up of 3 months–8 years, were asymptomatic except the one with 'true diverticulum' who remained symptomatic after TUR (Trans-urethral resection) and required vesicostomy. AUV and AUD both can cause obstructive uropathy. The proximal dilatation related to AUV cannot be labeled as a 'true diverticula', which lacks a classical orifice. The distal obstructing lip of 'true diverticula' should not be confused with a classical mucosal valve-like fold seen in AUV. While AUV and small AUD can be treated with endoscopic ablation, large diverticula as a result of wide spongiosal defects require surgical excision. A good understanding of their radiological and endoscopic anatomy is required to differentiate them and decide for appropriate management. Based on our experience, AUV and AUD should be differentiated and should be considered as two separate entities. Summary Figure Schematic diagram showing differences between AUV and AUD based on imaging and endoscopic findings: AUV is an obstructing mucosal valve causing proximal dilatation of the urethra forming a 'pseudodiverticulum', while AUD is a 'true diverticulum' as a result of spongiosal defect with a definite orifice in endoscopy and obstructing distal lip, forming an acute angle with the urethra in VCUG. Summary Figure [ABSTRACT FROM AUTHOR]

Abstract: The association of anterior urethral valve (AUV) with posterior urethral valve (PUV) is rare. A 7-month-old infant was presented at a district hospital with episodes of acute pyelonephritis. He was treated medically and a voiding cystourethrogram (VCUG) confirmed bilateral vesico-urethral reflux. The presence of concomitant AUV and PUV was not recognized. He underwent several surgical procedures, which failed. He had reflux recurrence following two antireflux procedures. He had urinary retention after each operation, which was managed by vesicostomy and perineal urethrostomy. At the age of 3.5years, he was referred to our paediatric urology clinic. Noticing the AUV and PUV in the past VCUG, the valves were fulgurated. Urodynamic study before and 3months after valve ablation showed a high voiding pressure. VCUG 6months following ablation showed no reflux, but several uroflowmetric studies showed a staccato and interrupted pattern. Empirical treatment with an alpha-blocker was started. One year after treatment, a repeat VCUG showed no reflux. Uroflowmetry and urodynamic studies returned to normal. The perineal urethrostomy was closed. The child was asymptomatic after 9months of follow up. [Copyright &y& Elsevier]

Abstract Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end-stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions. [ABSTRACT FROM AUTHOR]

Congenital abnormalities of the anterior urethra other than hypospadias (valve, diverticulum, and megalourethra) are rare conditions and can be difficult to diagnose. Based on five recent cases of these urethral abnormalities, we review the embryology and the English literature, and have found reports of about 100 cases of valve and diverticulum and 50 cases of megalourethra. For all these abnormalities, the clinical presentation depends on age and the diagnosis depends essentially on voiding cystourethrography, which must show the entire urethra, and careful urethroscopic examination. [ABSTRACT FROM AUTHOR]

The case of an 11-year-old boy with an anterior urethral valve is reported. A weak urinary stream and urinary dribbling were his main symptoms. Clinical evaluation consisted of renal ultrasonography, an intravenous urogram, a voiding cystourethrogram, and panendoscopy. Transurethral excision of the valve achieved a satisfactory result. [ABSTRACT FROM AUTHOR]