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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Factors affecting renal scarring in posterior urethral valves
K L Narasimhan1, S K Chowdhary, Balpinder Kaur
1Department of Pediatric Surgery, Post-Graduate Institute, PGIMER, Chandigarh, UT 160 012, India. narasimhankannan@hotmail.com
Journal of Pediatric Urology
|October 25, 2008
Summary
Breakthrough urinary tract infections (UTI) and diurnal incontinence significantly increase the risk of renal scarring in patients with posterior urethral valves (PUV). Poor ureteral drainage also correlates with scarring, highlighting key factors for monitoring and intervention.
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Imaging
Background:
- Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- Renal scarring is a significant complication that can lead to long-term renal dysfunction.
- Identifying factors associated with renal scarring is crucial for optimizing patient management.
Purpose of the Study:
- To retrospectively analyze the incidence of renal scarring in patients diagnosed with posterior urethral valves (PUV).
- To investigate the correlation between renal scarring and various clinical factors, including treatment, urinary tract infections (UTI), incontinence, vesicoureteral reflux (VUR), and renal drainage.
Main Methods:
- Retrospective review of 52 patients treated for PUV, excluding those with VUR dysplasia syndrome.
- Classification into groups based on dimercapto-succinic acid (DMSA) scan findings: no renal scarring (n=18) vs. renal scars present (n=34).
- Statistical correlation analysis of renal scarring with treatment mode, breakthrough UTI, incontinence, VUR, serum creatinine, ureteral drainage (DTPA scans), and bladder dysfunction.
Main Results:
- Renal scarring was observed in 34 patients (65%), with 14 having bilateral and 20 unilateral scarring.
- No significant impact of initial treatment mode or presence/severity of VUR on renal scarring.
- Significant correlations found between renal scarring and diurnal incontinence (P≤0.007) and breakthrough UTI (P≤0.002).
- Slow ureteral drainage on DTPA scans also showed a strong correlation with renal scarring (P≤0.0005).
Conclusions:
- Breakthrough UTI, diurnal incontinence, and poor ureteral drainage on DTPA scans are significant risk factors for renal scarring in PUV patients.
- Short-term renal scarring incidence is not significantly affected by the initial treatment, VUR, or bladder abnormalities.
- Retarded somatic growth was noted in both scarred and non-scarred groups compared to healthy children.
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