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Background: Multiple urethral anomalies are rare with its own challenges in diagnosis and management. The double urethral obstructions are often missed as proximal obstruction can mask the early diagnosis of distal obstruction. We present a rare case of concomitant posterior urethral valve (PUV) and anterior urethral valve (AUV) with a large anterior urethral diverticula (AUD) and hypospadias. Case Presentation: An 11-month-old male child after fulguration of PUVs continued to have urinary symptoms. He was subsequently found to have distal urethral obstruction because of AUV and large anterior urethral bulbar diverticula. He also had associated glanular hypospadias. He was managed with endoscopic ablation of AUV and diverticulectomy. Conclusion: Concomitant PUV, AUV, AUD, and hypospadias is a rare occurrence. The diagnosis and management can be challenging in such cases with multiple anomalies. To avoid a misdiagnosis, a high index of suspicion, proper assessment of urethrogram, and detailed cystourethroscopy is required.

Congenital anterior urethral diverticulum is a rare condition causing lower urinary tract obstruction in children. It usually arises from the ventral aspect of the anterior urethra, mostly located at the penoscrotal junction. We report a case of a 14-month-old baby boy who presented with a soft ventral swelling over the distal penile urethra, difficulty in passing urine, and a history of recurrent febrile urinary tract infections. A retrograde urethrogram revealed a large distal anterior urethral diverticulum. He underwent diverticulectomy and primary repair with no post-operative complications. The treatment of these depends on the size of the diverticulum and the degree of obstruction. In cases of a large anterior urethral diverticulum, open diverticulectomy and primary repair are recommended.

Anterior urethral valves are a rare cause of obstructed voiding in adolescent children and are often unheard by adult urologists. In this case report, we discuss the management of two adolescent patients who were referred to us with obstructive voiding symptoms with a diagnosis of neurogenic bladder and posterior urethral valves respectively but on evaluation were found to have anterior urethral valves. This article highlights the need for considering anterior urethral valve as an important differential diagnosis in children and adolescents presenting with obstructive voiding symptoms so as to avoid delay in diagnosis and management in young boys.

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.

Anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children. These are much rarer than posterior urethral valves. We report a case of a child with AUV and high grade bilateral vesicoureteric reflux. He was managed by transurethral laser ablation. The left sided reflux resolved after ablation. The right sided reflux persisted. The child is awaiting ureteric reimplantation.

Anterior urethral valve is an uncommon abnormality whose etiology is uncertain, unlike in the case of posterior urethral valve. Glanular anterior urethral valve is even rarer. We present an unusual case of anterior urethral valve, which presented with acute urinary retention and was successfully managed with excision and glans reconstruction. A history of poor stream and dribbling, recurrent urinary tract infections and palpable penile or peno-scrotal mass strongly points to the diagnosis of anterior urethral valve. A voiding cystourethrogramme confirms the diagnosis. It can cause early proximal urinary tract damage and renal failure if not intervened in time. Early surgical intervention will prevent the onset of uremia. Transurethral resection is the treatment of choice.

Voiding dysfunction and lower urinary tract symptoms (LUTS) in children due to congenital anomalies of urogenital system is common, but congenital anterior urethral diverticulum (CAUD) in male is very rare. Sometimes the problem is associated with anterior urethral valve. CAUD with secondary stone is rare. Here we report a case of a 12-year-old male child with obstructive symptoms. It was treated by excision of diverticulum, removal of stone and primary repair.J Enam Med Col 2017; 7(3): 162-164

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 valve (AUV) is a long known but rare anomaly, which is occasionally encountered in boys with obstructive uropathy. We present a case of Anterior urethral valve which was misdiagnosed as neurogenic bladder and was planned for Augmentation cystoplasty with catheterizable stoma elsewhere. This article highlights the frequently missed diagnosis of Anterior urethral valve by most practitioners because of its rarity. JMS 2015; 18(2):150-152

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.

Anterior urethral valve (AUV) is extremely rare entities. It is an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. The symptoms mimic those of posterior urethral valves. Because of rarity, less common presentations in children and lack of awareness among the pediatrician and pediatric surgeons, it can be easily missed.

Anterior urethral valve (AUV) associated with posterior urethral valves (PUVs) is an extremely rare congenital urologic anomaly resulting in lower urinary tract obstruction. We present our experience with 2 children with concomitant AUV and PUV as well as a literature review. The clinical presentation of concomitant AUV and PUV is variable. Successful endoscopic management can result in improvement in renal function, reversal of obstructive changes, and improvement or resolution of voiding dysfunction.

Objective- To report our experience of aetiology, diagnosis, management and outcomes of uncommon male urethral diverticula managed at a single institute.Patients and Methods: After due approval from local ethical committee the case records of 8 male patients including a child presenting with urethral diverticula in a 10 year period (2002-2012) were retrospectively analysed with regard to presentation, diagnosis, management and outcomes.Results: A total of eight patients were identified having been managed for a urethral diverticulum during the period. Of the eight patients one was congenital diverticulum and rest acquired. A child aged 10 years, presented with straining to void and inability to empty the bladder and was diagnosed to have anterior urethral valve located at peno-scrotal junction. The valves were endoscopically resected and diverticulum de-roofed. The child recovered with good outcome of good flow and emptying of bladder. Patients with acquired diverticula, presented at a mean age of 42 years (25-60 years). The presentation was similar with two patients presenting with acute retention. The Aetiological factors included Trauma, Previous urethral surgeries like Visual internal urethrotomy and infection. The common site of diverticula was peno-scrotal junction, followed by distal penile urethra. Two patients were treated with primary excision and establishment of urethral continuity and rest with two stage procedures. The outcome was poor in one patient of primary excision who presented later with stricture at the anastamotic site.Conclusions: Unlike in female population, male urethral diverticula are uncommon but should always be thought of in young men with obstructive urinary symptoms and in those with a past history straddle injuries. Treatment if individualized leads to good outcomes.

A case of anterior urethral diverticulum in a 12 years old boy who presented with obstructive urinary symptoms is described. The diagnosis was made on retrograde urethrography. Open diverticulectomy and urethroplasty was done with complete excision of obstructing anterior valve. The clinical presentation, diagnosis, and management of this rare condition is discussed.

SUMMARY An anterior urethral valve causing bladder outlet obstruction in children is rare. The early identification and management of this condition is crucial as delay may lead to chronic renal damage. We present a case of a 10-month old male child diagnosed with an anterior urethral valve by micturating cystourethrogram. This case emphasizes the importance of visualizing the whole of the penile urethra in performing a paediatric MCU examination or this important diagnosis may be missed.

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

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.

We present a neonate with an obstructing anterior urethral valve depicted by longitudinal transpenile ultrasound. Voiding images are recommended to identify the obstructing valve tissue. Ultrasound depiction of the anterior urethral valve tissue is identical to that seen in posterior urethral valves.

4 children with anterior urethral valve were treated by TUR-Valve. Before TUR, valve anatomy could be easily seen by antegrade urethroscopy through cystostomy using a 10.8Fr caliber flexible renoureteroscope and destruction of the valve could be recognized after TUR. Antegrade urethroscopy with a flexible fiberscope was so helpful to TUR-Valve and the findings of voiding cystourethrography and micturition have remarkably improved. This technique is not so difficult to apply and thought to be one of the best methods to recognize valve anatomy and degree of resection. This technique is also applicable to other lower urinary tract lesions in children.

Antegrade urethroscopy was performed through a cystostomy using a 10.8-fr caliber flexible renoureteroscope in 4 children (aged 2 years and 8 months, 2 months, 14 years and 1 month) with anterior urethral valve. The anatomy of the valves as well as their destruction after transurethral resection (TUR) were well visualized by antegrade urethroscopy. This technique was helpful in performing TUR-valve, after which the findings of voiding cystourethrography in every case and the findings of uroflowmetry in the elder 2 cases showed remarkable improvement. This technique is relatively simple to perform and is thought to be one of the best methods to treat anterior urethral valve. This technique is also applicable to other lower urinary tract lesions in children.

The anterior urethral valve (AUV) is a rare congenital urethral anomaly that can lead to variable urinary tract symptoms. We report on a 13-year-old boy with AUV who was referred from a primary care physician for nocturnal enuresis. AUV was disclosed by videourodynamic study and confirmed by simultaneous retrograde cystourethroscopy and antegrade urethroscopy. The AUV was ablated by neodymium:yttrium-aluminum-garnet contact laser at the 5-o'clock and 7-o'clock directions. A postoperative videourodynamic study depicted a patent urethra, a good maximal flow rate, and improved bladder capacity. His nocturnal enuresis had completely subsided at a follow-up period of longer than 24 months.

Purpose: To report a novel method for treating anterior urethral valves in children using the holmium:YAG laser. Case Report: A 2-year-old boy presented with symptoms of urinary-outflow obstruction. A micturating cystourethrogram (MCUG) revealed an abrupt narrowing of the penile urethra. At cystourethroscopy, an anterior urethral valve without a diverticulum was visible. This was ablated endoscopically using the Ho:YAG laser. The child voided successfully and was discharged the next day. Repeat MCUG 6 months later revealed a normal-caliber urethra. Conclusion: Holmium:YAG laser ablation of anterior valves is a minimally invasive treatment modality that provided a satisfactory result and appears to be very promising.

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.

In the past 3 years, eight of 20 male neonates with stigmata of the VATER association were found to have significant urethral abnormalities. Three had megalourethra, two had duplication of the urethra, and one each had an anterior urethral valve, congenital stricture, and hypospadias. In only five of eight was the extent of the abnormality clinically apparent. All three infants with megalourethra and imperforate anus died because of the coexistence of other severe congenital anomalies. Prior literature has described but not stressed the increased prevalence of urethral abnormalities in children with the VATER association. Because of the high prevalence (eight of 20) of significant urethral anomalies, we perform voiding cystourethrography on all males with the stigmata of the VATER association, even in the absence of clinical symptoms.

A rupture of the fetal bladder that resulted in urinary ascites has rarely been reported in published studies. We present the first case of a spontaneous rupture of the fetal bladder, due to an anterior urethral valve, in which the diagnosis was suspected prenatally by means of Doppler ultrasonography and was confirmed postnatally.

Despite a natural reluctance to burden the literature with individual case reports, the authors feel justified in presenting 2 cases of anterior urethral valve, since they were unable to find in the literature any account of this abnormality with accompanying roentgenograms. In only one textbook, Williams' Urology in Childhood (1), is the subject discussed, and in that instance only a diagram is reproduced. In the first of the 2 cases to be recorded here, there was a graphic roentgenologic demonstration of the valve. The diagnosis in each instance would have been missed if the rarely taken voiding urethrogram had not been obtained. The father of the first patient was a physician who had attended a number of lectures stressing the importance of a forceful urinary stream. He therefore watched his son urinate and observed that the child's stream lacked the normal projectory little boys so proudly demonstrate. This was the sole complaint which led to a request for an intravenous urogram. In the second case, a...