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Published on: October 12, 2017
Posterior urethral valves: the scenario in a developing center
S K Chatterjee1, S Banerjee, D Basak
1Department of Surgery, Park Children's Center for Treatment and Research, Calcutta, India.
Insights
Posterior urethral valves (PUV) management in 233 Indian children over 20 years showed primary valve ablation success. However, a high diversion rate and suboptimal long-term follow-up require attention.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Renal Health
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants, leading to bladder outlet obstruction.
- Long-term outcomes and management strategies for PUV require continuous evaluation.
Purpose of the Study:
- To review the clinical presentation, diagnosis, and treatment outcomes of 233 patients with posterior urethral valves.
- To assess the efficacy of primary endoscopic valve ablation versus diversion procedures.
- To identify challenges in long-term follow-up and propose improvements.
Main Methods:
- Retrospective review of 233 patients diagnosed with posterior urethral valves over a 20-year period.
- Analysis of clinical presentation, diagnostic methods, and surgical interventions (primary valve ablation, diversion).
- Evaluation of short- and long-term patient outcomes, including mortality, renal function, and overall health status.
Main Results:
- Primary endoscopic valve ablation was performed in 60% of patients, while diversion was used in 43%.
- Of the 233 patients, 11 died during initial hospitalization, and 15 developed end-stage renal disease.
- 169 patients remain in good health after 1-20 years of follow-up, but concerns exist regarding high diversion rates and follow-up adherence.
Conclusions:
- Primary valve ablation can yield excellent results in carefully selected patients with posterior urethral valves.
- The study highlights a need to reduce the rate of urinary diversion and improve long-term patient follow-up strategies.
- Ongoing efforts focus on refining management to mitigate these identified challenges.
Abstract:
We have reviewed 233 patients with posterior urethral valves treated in a single center in Calcutta, India, over the last 20 years: 37 were neonates, 75 were between 1 and 12 months, 88 were between 1 and 5 years, and 33 were more than 5 years old when first seen. The clinical presentation and methods employed in diagnosis and assessment are described. Primary endoscopic valve ablation was performed in 140 patients (60%). One or other form of diversion was done in 100 (43%), 93 before and 7 either during or after valve ablation. The short- and long-term results have been studied. Eleven patients died during the initial hospitalization, 3 died subsequently, 15 are in end-stage renal disease, 17 are in poor health, and 18 have been totally lost to follow-up. The remaining 169 have been in good health for periods between 1 and 20 years. While our results of primary valve ablation in low-risk patients with responsible parents are as good as anywhere else in the world, we are concerned at our relatively high diversion rate and relatively poor long-term follow up; the methods being adopted to reduce these problems are discussed.
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