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Published on: January 7, 2019
Predicting renal outcomes in children with anterior urethral valves: a systematic review
Jonathan C Routh1, Shawn M McGee, Richard A Ashley
1Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, USA.
Insights
Congenital anterior urethral obstruction in children typically has a good prognosis. However, a combination of pretreatment azotemia, vesicoureteral reflux, and urinary tract infection significantly predicts a poor renal outcome.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Abnormalities
Background:
- Congenital anterior urethral valves or diverticulum are rare conditions in children.
- Limited prognostic information exists for these conditions, particularly regarding renal outcomes.
Purpose of the Study:
- To identify clinical features that predict a poor renal outcome in children with congenital anterior urethral obstruction.
- Define poor renal outcome as azotemia, renal failure, or death.
Main Methods:
- Systematic literature review of 97 English language studies.
- Inclusion of 7 patients from institutional databases.
- Multivariate analysis to identify predictive factors for poor renal outcome.
Main Results:
- Of 139 included male patients, 78% had normal renal function post-treatment.
- Pretreatment azotemia and vesicoureteral reflux were independently associated with poor renal outcome.
- The combination of pretreatment azotemia, vesicoureteral reflux, and urinary tract infection increased the odds of a poor renal outcome 25-fold.
Conclusions:
- Congenital anterior urethral obstruction generally has a favorable prognosis.
- Pretreatment azotemia, vesicoureteral reflux, and urinary tract infection are key predictors of poor renal outcomes in affected children.
Purpose:
Prognostic information is limited on children with congenital anterior urethral valves or a diverticulum. We reviewed the literature and examined our clinical database to identify clinical features predicting a poor renal outcome, defined as azotemia, renal failure or death.
Materials And Methods:
We reviewed 97 English language studies of patients 18 years old or younger. Seven patients from our institutions were also included in analysis. After data abstraction we used multivariate models to define factors associated with outcomes of interest.
Results:
We identified 239 male patients with anterior urethral valves, of whom 139 had adequate data available for study inclusion. Of these patients 108 (78%) had normal renal function after treatment. On bivariate analysis vesicoureteral reflux (OR 22.4, p <0.0001), pretreatment azotemia (OR 17.1, p <0.0001), urinary tract infection (OR 3.3, p = 0.006), hydronephrosis (OR 10.0, p = 0.0004) and bladder trabeculation (OR 7.3, p = 0.01) were associated with renal failure or death while treatment method (p = 0.9), obstruction type (valve vs diverticulum, p = 0.4) and valve location (p = 0.6) were not. After adjusting for other factors only pretreatment azotemia (p = 0.0005) and vesicoureteral reflux (p = 0.01) remained associated with renal failure and/or death with a trend toward significance for urinary tract infection (p = 0.06). When all 3 factors were present, the odds of a poor renal outcome increased 25-fold (p = 0.005).
Conclusions:
Congenital anterior urethral obstruction in children has a generally good prognosis but may occasionally result in a poor renal outcome. The combination of pretreatment azotemia, vesicoureteral reflux and urinary tract infection is highly predictive of a poor renal outcome.
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