[Management of the upper urinary tract in boys with posterior urethral valves (65 cases) (author's transl)].
The authors study the management of the upper tract in 65 boys with posterior urethral valves from 1965 through 1978. Their behaviour has changed with time. At the beginning of their experience they used systematically urinary cutaneous diversion (18 cases : 9 good results -- 4 deaths -- 5 poor results). In a second period they used extensive surgical reconstruction at the same time as with destruction of the valves according to H.W. Hendren. Results were very bad : 5 cases: 1 good result, 3 poor results -- 1 death. During the later years of this study (1973 to 1978) 42 boys were managed by primary destruction of the valves. 22 required only valve ablation and recovered with a good upper tract. 6 severely ill infants who did not respond to valve ablation alone were nephrostomy (2) or ureterostomy (4) diverted (4 good results). In 14 additional patients a ureteral reimplantation was required : 8 successes -- 6 failures. Our experience supports the thesis that after primary resection alone the severely dilated and tortuous ureters usually improve strikingly with time. A period of watchful waiting before undertaking ureteral reimplantation is recommended. Measurements of ureteral pressure also are beneficial in determining the need for surgical intervention (Whitaker). Temporary ureteral diversion has a place in the severely ill patient who has not responded to valve resection.