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前部尿道弁は下部尿路閉塞症の原因として, 後部尿道弁に比べて稀な疾患である。さらに, 舟状窩における前部尿道弁はきわめて稀である。われわれは尿線の分裂を主訴に受診した, 6歳, 男児の前部尿道弁に関して報告する。膀胱鏡にて前部尿道弁と診断し, 内視鏡的切開にて治療しえた。尿線の異常を訴える小児においては, 前部尿道弁の可能性も考慮すべきである。(著者抄録), An anterior urethral valve is uncommon compared to a posterior urethral valve as a cause of lower obstructive uropathy. Furthermore, an anterior urethral valve in the fossa navicularis is extremely rare. We describe the case in a 6-year-old boy who presented with a split urinary stream. Endoscopy revealed an anterior urethral valve in the fossa navicularis, and we successfully incised the valve with a hook knife. We should consider the possibility of an anterior urethral valve in any child with an abnormal urinary stream.

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.

The reason of the obstructive voiding abnormalities in children may be functional or mechanical. We report an anterior urethral valve associated with a wide mouthed congenital urethral diverticulum in a child. The flap-like distal margin which acts as an obstructing valve and the proximal margin of the diverticulum were incised endoscopically with electrocautery in the midline. He was voiding well in the eight-month followup period. Especially in children with voiding dysfunction, anterior urethra must be examined carefully to prevent misdiagnosis of the recognizable lesions.

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...