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Long-term outcome of boys with posterior urethral valves
H F Parkhouse1, T M Barratt, M J Dillon
1Department of Paediatric Nephrology, Institute of Child Health, London.
Insights
Posterior urethral valves (PUV) in boys can lead to long-term kidney problems, especially with early diagnosis and reflux. Persistent bladder issues significantly impact renal function outcomes.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Abnormalities
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- Early diagnosis and management are crucial for long-term outcomes.
Purpose of the Study:
- To evaluate the long-term renal outcomes in boys diagnosed with posterior urethral valves.
- To identify factors associated with poor renal function in this cohort.
Main Methods:
- Retrospective review of 114 boys treated for posterior urethral valves between 1966 and 1975.
- Long-term follow-up of up to 22 years, assessing renal function and associated factors.
Main Results:
- One-third of patients experienced a poor long-term renal outcome.
- Early presentation (under 1 year), bilateral vesicoureteric reflux, and daytime incontinence after age 5 were associated with adverse outcomes.
- Primary valve ablation showed better outcomes than temporary upper tract diversion.
Conclusions:
- Posterior urethral valves significantly impact long-term renal function in a substantial proportion of patients.
- Early presentation, vesicoureteric reflux, and persistent bladder dysfunction are key determinants of poor renal outcomes.
- Management strategies should address bladder dysfunction to improve long-term renal health.
Abstract:
One hundred and fourteen boys with posterior urethral valves were treated between 1966 and 1975. Four died during the first hospital admission, 6 died from renal failure during childhood, 1 died from other causes and 15 were lost to follow-up. Eighty-eight were reviewed 11 to 22 years after diagnosis and the renal outcome of 98 patients is therefore known. Approximately one-third of patients presented under 1 month of age, between 1 month and 1 year, and over 1 year respectively. Bilateral vesicoureteric reflux was observed in one-quarter of the boys, more frequently in those presenting in the first month of life. Half of the patients were treated by primary valve ablation and half underwent temporary upper tract diversion: the outcome was worse for the diverted group. One-third of the boys had a long-term bad outcome for renal function. This outcome was associated with early presentation, bilateral vesicoureteric reflux and day-time urinary incontinence after the age of 5 years. The association of bad outcome with incontinence points to continuing bladder dysfunction as a major determinant of long-term outcome for renal function.