Suggest Treatment For Posterior Urethral Valve In A Child

Hi, may I answer your health queries right now ? Please type your query here... I beg to draw your kind attention that I am Dr. Sudipta Das working as Medical Officer in Deben Mahato (Sadar) Hospital, Purulia, West Bengal.I am willing consult with you about my son who is suffering from Posterior Urethral Vulve. My son (Name:Abhraneel Das, Date of birth:15/06/08, Present age:2year and 3 month, Weight:10.75kg, Height:85 cm) was quite well till age of 8 month. In next three month (8-11 month) he was not gaining Wt. properly. Pediatrician advised for Urine R/E and C/S. In Urine R/E Pus cell was: 25-30/hpf and C/S is positive with colony count more than 1 lakh. He is given full course of Antibiotic and after recovery his wt. gain was better.He is kept under Prophylactic Antibiotic. After the first attack USG KUB Region done twice at age of 11 and 13 month were with in normal limit.DMSA Scan done at age of 13 month, Impression: Both kidneys are of average size and show satisfactory cortical function with evidence of minimal parenchymal inflammation. There is no evidence of scarring in either kidney. Differential function-Left kidney-51%, Right kidney-49%. MCU done at age of 1year and 5 month. According to MCU Report Posterior Urethra is dilated with residual urine in bladder but no Reflux. He is referred to Pediatric Surgeon. Surgeon is advised for Cystoscopy which was done at his age of 1year and 6 month. According to Operative note posterior urethra is dilated. Flimsy cusp on rt. side, fulgurated. Both Ureter openings are normal. DTPA Scan was advised 6 weeks after cystoscopy. Impression of DTPA Scan: Both kidneys are of average size and shape with normal perfusion and normal cortical function. There is no evidence of obstruction in either kidney. Total GFR estimated 114.14ml/min, Differential function- Left kidney-46.67%, Right kidney-53.33%. He is advised for follow up after 6 month. At age of 2 year and 1 month again MCU done. Posterior urethra was till dilated with residual urine in bladder with no Reflux. I consult with another Pediatric Surgeon who advised for repeat Cystoscopy. Again Cystoscopy done at age of 2 year and 2 month. According to operative note Posterior urethral Vulve found and fulgurated at 5,7and 12 0’clock position. He is advised for cheek Cystoscopy after 2 month. My child is now under Antibiotic Prophylaxsis (Co-trimoxazole). His urinary flow is improved after cystoscopy 2nd time. His serum Creatinine level was cheeked thrice their value are: 0.6mg/dl at age of 1year and 5 month 0.6mg/dl at age of 2year and 1 month 0.4mg/dl at age of 2year and 2 month His urine was examined several times after first attack of UTI and it was positive once with pus cell count 12-15/hpf and colony count 80000 in C/S at age of 2 year and 1 month. I am very much anxious about future of my child. I shall be highly obliged if you kindly give your valuable opinion regarding present management (is MCU required before cheek cystoscopy), Follow-up protocol and Prognosis of my child. Eagerly waiting for your reply . Thanking you,