Related Experiment Videos
[Posterior urethral valves: prognosis related to the initial surgical treatment]
Insights
Early urinary tract diversion for posterior urethral valves improves renal function in boys. This management strategy led to better outcomes and higher Glomerular Filtration Rate (G.F.R.) compared to other methods.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- Severe PUV can lead to significant renal damage and long-term complications.
Purpose of the Study:
- To review the long-term outcomes of boys diagnosed with severe posterior urethral valves.
- To compare the effectiveness of early upper urinary tract diversion versus valve ablation for managing severe PUV.
Main Methods:
- Retrospective review of 32 boys with severe posterior urethral valves.
- Categorization into two groups: Group A (early upper urinary tract diversion) and Group B (valve ablation or vesicostomy).
- Assessment of renal function (G.F.R.), growth parameters, and need for further surgical interventions.
Main Results:
- Fifteen patients achieved a G.F.R. > 80 ml/min/1.73 m2, with 73% in the early diversion group.
- Patients treated with ureterostomy or pyelostomy showed higher average height and weight post-treatment.
- Two patients developed end-stage renal disease.
Conclusions:
- Early upper urinary tract diversion in boys with severe posterior urethral valves is associated with improved renal function.
- Surgical management involving early diversion may lead to better long-term growth outcomes.
Abstract:
Long-term outcome of 32 boys with severe posterior urethral valves is reviewed. Diagnosis was established during the first month of life in 14 patients, along the first year in another 14 and later in five. Surgical management was, initially, bilateral upper urinary tract diversion (cutaneous ureterostomy or pyelostomy) in 17 patients (Group A), and valve ablation alone or vesicostomy in 15 children (Group B). Eight months was the mean age of patients at initial surgery (40% before the first month of life). The average age for closure of the temporary urinary diversion was 17 months. Eleven patients underwent later unilateral nephrectomy and eighteen antireflux surgical procedures. Follow-up ranged from 1 to 15 years (mean 6 years). Fifteen patients have a Glomerular Filtration Rate (G.F.R.) of more than 80 ml./min./1.73 m2. Eleven (73%) of them underwent early upper urinary tract diversion, and the remaining four (27%) underwent valve ablation or vesicostomy. Two children among the 32 have developed end stage renal disease. Average height and weight posttreatment values were higher in those patients treated with ureterostomy or pyelostomy. The results of our study suggest that renal function improved in patients with early upper urinary tract diversion.