Delayed presentation in posterior urethral valve: long-term implications and outcome

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Outcomes

Background:

• Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
• Delayed diagnosis of PUV can lead to significant renal damage and long-term complications.

Purpose of the Study:

• To analyze the impact of delayed presentation of posterior urethral valves on long-term outcomes in children.
• To identify prognostic factors for children with PUV.

Main Methods:

• A retrospective analysis of 194 children with PUV who underwent surgical ablation.
• Patients were divided into two groups based on age at presentation: Group I (<2 years) and Group II (>2 years).
• Data on presenting complaints, azotemia, serum creatinine, surgical outcomes, and long-term renal function were analyzed.

Main Results:

• Group II (late presenters) showed significantly higher rates of azotemia (81.8% vs 32.6%) and higher mean serum creatinine levels compared to Group I.
• Voiding improvement after ablation was significantly lower in Group II (20.4% vs 86.1%).
• Long-term renal insufficiency developed in 40.8% of Group II patients versus 30.5% of Group I patients.

Conclusions:

• Delayed presentation of PUV beyond 2 years of age is associated with poorer outcomes, including a higher risk of chronic renal insufficiency.
• Serum creatinine levels at presentation and 1 year post-ablation, along with persistent VUR and voiding dysfunction, are key prognostic indicators.
• Pediatric patients with PUV presenting after 2 years require cautious management due to increased risks.