Outcome of Endoscopic Fulguration in Patient with Posterior Urethral Valve

Background: In developing countries like Bangladesh, posterior urethral valves (PUV) are typically diagnosed postnatally, whereas in developed countries, they are often identified prenatally. Early diagnosis, complete fulguration, and regular follow-up are crucial to prevent renal impairment in PUV patients. Objective: This study aimed to evaluate the outcomes of endoscopic fulguration in PUV patients in a Bangladeshi medical setting. Method: Conducted at the Department of Urology, Dhaka Medical College & Hospital, this observational study spanned from July 2018 to June 2019. Thirty-five patients meeting inclusion and exclusion criteria were initially included, with five dropping out during follow-up. Endoscopic valve ablation was performed on all patients, followed by catheterization for 14 days. Post-procedure, patients were discharged within 48-72 hours with oral antibiotics and behavioral therapy advice. Follow-up visits over six months included assessments of height, weight, urine analysis, serum creatinine, kidney ultrasonography, and eGFR. Voiding cystourethrograms were performed at one- and six-months post-fulguration. Result: Most patients presented at ages 11-20 months (36.7%) and 21-30 months (26.67%). Poor urine stream and dribbling were the most common symptoms, seen in 83.33% and 76.67% of patients, respectively. Repeated fever was noted in 63.33% of patients, while 43.33% exhibited failure to thrive. VUR was present in 46.7% of patients; 42.86% had unilateral VUR and 57.14% had bilateral VUR. Following six months of fulguration, complete resolution of reflux occurred in 40% of right-side and 50% of left-side renal units. Decreased reflux grade was noted in 20% of right-side and 16.67% of left-side units, while persistence was seen in 40% and 33.33% respectively. Significant improvements in eGFR and serum creatinine levels were observed (p<0.001). Hydroureteronephrosis decreased from 22 to 8 cases, though this was not statistically significant (p=0.06). Conclusion: Endoscopic fulguration significantly improves renal function in PUV patients. About half of VUR cases resolved completely within six months post-procedure.