Posterior Urethral Valves with Severe Bilateral Reflux. Which is the Best Treatment?

PUV is maybe the biggest disease in pediatric urology. It can involve the lower and the upper part of urinary tract. Although the reflux in itself is considered a defense mechanism, many of these patients develop renal end stage disease. Treatment of PUVs remains a challenge, considering the long life management to prevent renal and bladder complications. In order to do that, it is necessary to follow the right steps from the moment of the diagnosis. We have been treating 51 patients with PUVs, associated with bilateral refluxing ureters, during a 10 years period, and also classified as third and fourth groups according to Hendren classification. We managed these patients in three ways, doing primary valve ablation or diverting urine through posterior vesicostomy or unilateral ureterostomy. After that we compared the timing of normalization of creatine levels for each group, and also the improvement of hydronefrosis during a period of one year. Our results suggest that commencing the treatment by ureterostomy, gives a faster reduction in creatinine levels and also a shorter normalization time of hydronedrosis.