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Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia
Hiwote G Assefa1, Hanna Getachew2, Amezene Tadesse2
1Department of Surgery, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia.
Insights
Posterior urethral valve (PUV) ablation in boys leads to a high rate of chronic kidney disease (CKD). Proteinuria, hypertension, and elevated creatinine are key risk factors for CKD development post-ablation.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Abnormalities
Background:
- Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys.
- Early diagnosis and intervention for PUV are crucial for preserving renal function.
- Long-term follow-up is necessary due to the varying impact of embryological insult.
Purpose of the Study:
- To assess the renal outcomes in patients after PUV ablation.
- Identify risk factors associated with the development of chronic kidney disease (CKD) post-ablation.
Main Methods:
- A descriptive retrospective study analyzing data from 70 patients who underwent PUV ablation between 2015 and 2019.
- Data collection focused on preoperative and postoperative parameters, including proteinuria, hypertension, and serum creatinine.
- Statistical analysis was performed to identify significant risk factors for CKD development, with a p-value threshold of ≤0.05.
Main Results:
- Over a 3-year follow-up, 52.9% of patients developed postoperative CKD, and 2.9% progressed to end-stage renal disease.
- Independent risk factors for CKD included preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine.
- A significant correlation was observed between delayed ablation after vesicostomy and poorer renal outcomes.
Conclusions:
- A high incidence of CKD was observed in patients following PUV ablation, consistent with findings in other studies.
- Proteinuria, hypertension, and elevated nadir serum creatinine were identified as independent risk factors for CKD progression.
- These findings highlight specific risk factors relevant to low- and middle-income country contexts.
Background:
Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care.
Objective:
To assess the renal outcome of patients following PUV ablation.
Methods:
This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value≤0.05 was considered significant.
Results:
Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD.
Conclusion:
There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low- and middle-income countries.
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