Long-term prognosis of renal function in boys treated for posterior urethral valves

This paper discusses the long-term prognosis of renal function in 84 boys treated for posterior urethral valves and followed up for a period ranging from 1-21 years. Thirty-one of the 84 patients (39.3%) were either adolescents or had crossed adolescence and this study highlights the changes through adolescence and puberty. Serum creatinine was found to be raised in 53% patients at presentation and 22.5% patients eventually progressed to chronic renal failure. Serum creatinine value 1 year after appropriate decompression of the urinary tract was a more accurate predictor of the eventual renal outcome rather than serum creatinine at presentation. Decompensation at puberty was detected in 3 patients in this study. The predisposing factors identified were the persistence of gross hydroureteronephrosis with voiding dysfunction after treatment in one patient and renal parenchymal disease in the other 2 patients. The "risk factors" for predicting a poor eventual renal function were persistently raised serum creatinine 1 year after decompression by diversion or fulguration, bilateral high grade vesicoureteral reflux, persistent severe upper tract dilatation after treatment, voiding dysfunction and delayed presentation. This study emphasizes the need to diagnose and intervene early, to investigate post-treatment persistent upper tract dilatation for vesicoureteral junction obstruction and for detrusor dysfunction by a complete urodynamic evaluation and to follow up these patients carefully through adolescence and adulthood.