Treatment of this condition will depend on severity of the obstruction, and, other complications at the time the condition is diagnosed. In those fortunate boys who are not in electrolyte imbalance, nor renal failure, nor gross infection the valves can be tackled immediately. The use of a Cystoscope a type of an endoscope that can be inserted into the urethra of the child is used to look at the urethra and bladder from inside. There are various sizes of the Cystoscopes including a very tiny one that can go inside the urethra of a newborn too. Using the Cystoscope-Resectoscope - I am able to visualize the valves from inside and with the resectoscope loop and cut them with a coagulating current and relieve the obstruction at one go. After the procedure a catheter is kept to drain the bladder of urine and keep the area cut dry. The catheter is removed after 3 days and the child passes urine on his own with a good stream. The child is sent home on that day, but, will need to come regularly for a follow up investigations. The USG will now show no residual urine, the upper tract dilatation should decrease over the years, the DTPA Scan should show a gradual increase in the percentile function of the kidneys.

Tiny Cysto - resectoscopes that can enter the newborns urethra

However, not all boys are so lucky to get away with such good results, some may be detected late or are born with very severe obstruction and bad complications. In such boys just a Cystoscopic resection of the valves will not be adequate to treat them. In these boys, the complications like the electrolyte imbalances, the infection needs to be controlled first, and then go for a cystosopic resection of the valves. At times to get over the renal failure and to decompress the back pressure on the upper tracts, there is a need to divert the urine proximal to the site of the obstruction. This is done by opening the bladder to the skin to allow the urine to drain out directly, or at times the ureter has to be taken to the skin to allow urine to flow freely and the pressure to come down, let the child grow, the renal function return to a good level and then do a Cystoscopic resection of the valves and then close the diverted urinary tract. Again the importance of the follow up for a long period has to be emphasized to look for improvement in the function. At times, despite all the best efforts, I have been unable to get the function above what it was when I began the treatment. Gradually some of these children will go into renal failure and the only final treatment available for these children is a Renal Transplant to save them. Treatment of complicated cases of PUV is very exacting, intricate and complicated with a day to day monitoring of these boys in an Intensive Care Unit with higher antibiotics, elctrolyte corrections, charting of the urine output on an hourly basis and so on. Suffice it to say this condition can be very simple or extremely complicated to manage depending on various factors already discussed.