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Prognosis for patients with prenatally diagnosed posterior urethral valves
Y Reinberg1, I de Castano, R Gonzalez
1Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis.
Insights
Prenatal diagnosis of posterior urethral valves (PUV) in children may lead to a higher risk of renal failure. Early detection did not significantly improve outcomes in this study.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Abnormalities
Background:
- Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- Early diagnosis of PUV is generally associated with better outcomes, but the impact of prenatal diagnosis is less understood.
Purpose of the Study:
- To investigate the clinical outcomes of children with posterior urethral valves (PUV) based on the timing of diagnosis (prenatal vs. neonatal).
- To identify predictors of renal failure in infants diagnosed with PUV.
Main Methods:
- Retrospective review of medical records for children with PUV treated between 1975 and 1990.
- Comparison of clinical outcomes, including renal failure and mortality, between prenatally and neonatally diagnosed groups.
- Analysis of factors such as nadir creatinine, oligohydramnios, and pulmonary insufficiency.
Main Results:
- Children diagnosed with PUV prenatally had a higher incidence of renal failure (64%) compared to those diagnosed neonatally (33%), though not statistically significant (p>0.05).
- Nadir creatinine > 1.2 mg/dL correlated with renal failure in both groups.
- Oligohydramnios and postnatal pulmonary insufficiency predicted progressive renal failure.
Conclusions:
- Prenatal diagnosis of posterior urethral valves may be associated with poorer renal outcomes.
- Earlier diagnosis and treatment did not appear to improve the clinical prognosis in this cohort.
- Identifying risk factors like oligohydramnios is crucial for managing infants with PUV.
Abstract:
Children in whom posterior urethral valves are diagnosed shortly after birth are at higher risk for renal failure than children in whom posterior urethral valves are diagnosed later in life. The influence of prenatal diagnosis of posterior urethral valves on clinical outcome has not been established. We collected data on children with posterior urethral valves treated since birth at our hospital between 1975 and 1990. The clinical outcomes for 8 patients diagnosed prenatally and 15 diagnosed neonatally were compared. Of the 8 patients in the prenatal group 5 (64%) had renal failure compared to 5 of 15 (33%) in the neonatal group (p greater than 0.05). Nadir creatinine of more than 1.2 mg./dl. correlated with the development of renal failure in all patients in the neonatal and prenatal groups. There was 1 death in the prenatal group. In our experience prenatal diagnosis of posterior urethral valves has grave implications, including a 64% incidence of progressive renal failure and a 64% incidence of transient pulmonary failure. Oligohydramnios and postnatal pulmonary insufficiency are predictive of progressive renal failure. Earlier diagnosis and treatment of children with posterior urethral valves did not improve the clinical prognosis.