Related Experiment Videos
Factors affecting outcome in the management of posterior urethral valves
1Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Early diagnosis and appropriate therapy are crucial for children with posterior urethral valves (PUV) to prevent renal failure (RF). Prompt treatment and monitoring serum creatinine levels significantly improve long-term kidney function outcomes.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Posterior urethral valves (PUV) pose a significant risk of renal failure (RF) in children.
- Early diagnosis and timely intervention are critical for preserving renal function.
Purpose of the Study:
- To evaluate the long-term renal function outcomes in children diagnosed with PUV.
- To identify factors influencing renal function recovery, including diagnostic timing and therapeutic strategies.
Main Methods:
- Retrospective review of 58 children with PUV, analyzing diagnostic age, treatment modalities, and follow-up renal function.
- Therapeutic choices included primary valve fulguration, vesicostomy, or high ureterostomy, based on response to initial bladder drainage.
- Serum creatinine levels were monitored to assess renal function over time.
Main Results:
- Endoscopic valve ablation was the most common primary procedure (56.8%).
- Neonates with RF at presentation showed significant recovery, while delayed diagnosis in older children led to poorer outcomes.
- Serum creatinine levels at 1 year post-decompression were predictive of long-term renal function; levels ≤0.8 mg/dl indicated good prognosis.
Conclusions:
- Serum creatinine at presentation is not predictive; post-decompression levels are more prognostically valuable.
- Delayed diagnosis of PUV significantly impairs renal function recovery.
- A stepwise, individualized therapeutic approach, or 'stepladder protocol', is essential for optimizing renal function in children with PUV.
Abstract:
Children with posterior urethral valves (PUV) are at high risk for renal failure (RF). The outcome of renal function is significantly influenced by early diagnosis and the choice of primary therapy. We reviewed the outcome of renal function in 58 children with PUV. The choice of therapy in each case primary valve fulguration, vesicostomy, or high ureterostomy--was individually decided on the basis of the response to initial catheter drainage of the bladder. Patient age at diagnosis varied from newborn to 5.5 years, and follow-up ranged from 1.6 to 6 years (mean 3.9 years). The most common procedure was primary endoscopic valve ablation, which was carried out in 56.8% of cases. The other procedures were vesicostomy in 32.75% and high ureterostomy in 10.45%. Most neonates (66.6%) had RF at presentation, but one-half of them had achieved normal serum creatinine values at last follow-up. The recovery of renal function was lowest (33%) in older children where the diagnosis was delayed. A comparison between two groups of neonates and infants who differed on the basis of creatinine concentrations at 1 year of age suggested a statistically significant trend: children with normal or near-normal serum creatinine (0.8 mg/dl or less) by 12 months of age maintained good renal function at the time of final evaluation (1.0 mg/dl or less). Children with higher creatinine values at 1 year of age continued to have progressive RF. Seventy-five percent of the patients who had undergone early high ureterostomy after failure to respond to initial catheter drainage had regained normal renal function. We conclude that: serum creatinine at presentation is not predictive of subsequent renal function, but the values after a period of urinary-tract decompression are prognostically more useful; delay in diagnosis results in a poor outcome of renal function; and for optimal recovery of renal function, the choice of the primary procedure varies from case to case and can be determined by a systematic, stepwise approach (stepladder protocol).