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A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys

Pauline M L Hennus1, Geert J M G van der Heijden, J L H Ruud Bosch

  • 1Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. P.M.L.Hennus@umcutrecht.nl

Plos One
|October 3, 2012
PubMed

Insights

Posterior urethral valves (PUV) treatment in boys can lead to significant kidney and bladder dysfunction. Elevated creatinine levels are a key predictor of renal failure in these patients.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Outcomes

Background:

  • Posterior urethral valves (PUV) cause urethral obstruction with a wide clinical spectrum.
  • PUV is a leading cause of chronic kidney disease in boys.
  • Understanding post-treatment dysfunction is crucial for managing PUV.

Purpose of the Study:

  • To determine the incidence of kidney and bladder dysfunction after endoscopic valve resection (EVR) for PUV.
  • To identify factors associated with adverse outcomes in boys treated for PUV.

Main Methods:

  • Systematic review of 34 studies involving 1474 boys treated with EVR.
  • Data extraction on patient characteristics, clinical presentation, and post-treatment risks.
  • Analysis of renal function, vesicoureteral reflux (VUR), incontinence, and bladder function.

Main Results:

  • High rates of chronic kidney disease (22%) and end-stage renal disease (11%) observed post-EVR.
  • Elevated nadir serum creatinine identified as the sole independent predictor of renal failure.
  • Vesicoureteral reflux decreased from 43% to 22% post-treatment; incontinence affected 19%, and bladder dysfunction was seen in 55%.

Conclusions:

  • Incidence of renal and bladder dysfunction post-EVR for PUV varies widely.
  • Lack of standardized obstruction quantification contributes to outcome variability.
  • Elevated nadir serum creatinine predicts renal dysfunction; objective classification of obstruction severity is needed.
Abstract

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