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Published on: January 7, 2019
Bladder function in children with posterior urethral valves: impact of antenatal versus postnatal diagnosis
Osama M Sarhan1,2, Bassem Wadie1, Fouad Al-Kawai2
1Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
Early diagnosis and treatment of posterior urethral valves (PUVs) in boys may preserve renal function. This intervention appears to offer optimal outcomes for kidney health without negatively impacting bladder function.
Area of Science:
- Pediatric Urology
- Congenital Abnormalities
- Nephrology
Background:
- Posterior urethral valves (PUVs) are a leading cause of congenital bladder outlet obstruction in male infants.
- Early detection and intervention are crucial for managing PUVs and preventing long-term complications.
Purpose of the Study:
- To evaluate the impact of early posterior urethral valve (PUV) diagnosis and fulguration on bladder function.
- To compare the functional and urodynamic outcomes of early versus delayed intervention for PUVs.
Main Methods:
- Retrospective analysis of 153 patients who underwent primary valve ablation between 2001 and 2018.
- Patients were divided into two groups: early intervention (antenatal diagnosis, n=69) and delayed intervention (postnatal diagnosis, n=84).
- Outcomes assessed included renal function, urodynamics, and upper urinary tract changes.
Main Results:
- The early intervention group showed a lower incidence of chronic kidney disease (CKD) (22% vs. 37%, p=0.04).
- While Q-max, mean bladder capacity, and post-void residual (PVR) volumes were similar, percent PVR was significantly higher in the delayed intervention group (p=0.002).
- Detrusor overactivity showed a non-significant difference between groups (p=0.07).
Conclusions:
- Primary ablation of posterior urethral valves (PUVs) in early neonatal life may optimize renal function.
- Early intervention for PUVs appears to preserve renal function without adversely affecting bladder function compared to delayed treatment.
Purpose:
Posterior urethral valves (PUVs) are the most common cause of congenital bladder obstruction in boys. Our aim was to assess the impact of early diagnosis and fulguration of PUVs on bladder function and compare their functional and urodynamic outcome with children who underwent delayed intervention.
Materials And Methods:
We retrospectively evaluated 153 patients who underwent primary valve ablation from two tertiary hospitals between 2001 and 2018. Patients have been divided into 2 groups, group 1 included 69 patients who were detected antenatally and underwent early fulguration of PUVs while group 2 included 84 children presented postnatally and underwent delayed valve ablation. The recorded data throughout follow-up in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated and compared.
Results:
Median age at time of valve ablation was 10 days in group 1 and 7 months in group 2. The median follow-up period was 6.5 and 7 years in group 1 and 2, respectively. Chronic kidney disease (CKD) developed in 15 (22%) boys in group 1 while in group 2 it was observed in 31 (37%), p=0.04. While Q-max, mean bladder capacity and post-void residual (PVR) volumes were comparable in both groups, percent PVR was significantly higher in group 2 (3.27 vs. 1.44, p=0.002). Detrusor overactivity was slightly different in both groups (p = 0.07).
Conclusions:
Compared to delayed intervention, primary ablation of PUVs during the early neonatal life possibly provides the optimum chance to have optimum renal function without impact on bladder function.
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