Клапан задней уретры у детей. Обзор литературы: ОБЗОРЫ

Кирилл Игоревич  Пелих; Евгения Александровна  Кашина; Илья Маркович  Каганцов

doi:10.56871/PED.2025.56.31.010

Posterior urethral valves in children. Literature review

REVIEWS

Kirill I. Pelikh Almazov National Medical Research Center, Saint Petersburg, Russia
Evgeniya A. Kashina Almazov National Medical Research Center, Saint Petersburg, Russia
Ilya M. Kagantsov Almazov National Medical Research Center, Saint Petersburg, Russia

Keywords:

клапан задней уретры почечная недостаточность клапанный мочевой пузырь пузырно-мочеточниковый рефлюкс абляция клапана дети posterior urethral valve renal failure valvular bladder vesicoureteral reflux valve ablation children

Abstract

The posterior urethral valve is the most common cause of infravesical obstruction in newborn boys with a prevalence of about 1 in 3800. The etiology is multifactorial, associated with impaired embryogenesis in the 4th week of pregnancy with abnormal fusion of the mesonephral ducts with the cloaca. The pathogenesis includes mechanical obstruction of the urethra, leading to increased intravesical pressure, secondary changes in the bladder (detrusor hypertrophy, trabecularity), vesicoureteral reflux (up to 50% of cases) and progressive kidney damage. Prenatal ultrasound can diagnose up to 47% of cases based on the following symptoms: bilateral ureterohydronephrosis, megacystis, keyhole symptom, oligo-/anhydramnion. The basis of treatment is early endoscopic valve ablation in the first months of life and the initiation of drug therapy with M-holinoblockers (oxybutynin), which improves urodynamics and prognosis. If primary ablation is not possible, temporary urine withdrawal (catheterization, cystostomy) is used. Long-term complications include the formation of a “valvular bladder” with neurogenic dysfunction, persistent vesicoureteral reflux, chronic kidney disease (develops in 30–50% of patients), which requires constant dynamic monitoring, urodynamic control, and in some cases, augmentation cytoplasty or renal replacement therapy. Prenatal diagnosis and early minimally invasive intervention remain key to improving outcomes.

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