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

M S Ansari1, Pratipal Singh, Anil Mandhani

  • 1Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. ansarimsa@hotmail.com

Urology
|March 1, 2008
PubMed

Insights

Delayed presentation of posterior urethral valves (PUV) in children over 2 years old is associated with higher risks of azotaemia and chronic renal insufficiency. Early diagnosis and intervention are crucial for better long-term outcomes in PUV patients.

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.
Abstract

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