Bilateral high loop ureterostomy in the primary management of posterior urethral valves in a developing country

Of 200 consecutive cases of posterior urethral valves (PUV) managed in a single institution, 26 underwent bilateral high loop ureterostomy (BU) as their first operative intervention. Indications for BU were persistently raised serum creatinine levels after bladder drainage, severe urosepsis, and urinary ascites, especially in a neonate or infant. After a median period of 1 year of diversion, the serum creatinine fell from a median value of 2.5 to 0.6 mg%. Twelve cases have been fully undiverted without deleterious effects (median serum creatinine level 0.5 mg%). Three patients died. Of the 14 renal units with documented persistent vesicoureteric reflux at the time of undiversion, only 1 has been reimplanted. One child has undergone bladder augmentation.