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Clinical Profile, Management, and Outcome of Posterior Urethral Valves in Children - Experience from a Tertiary Care
Gali Divya1, Vijay Kumar Kundal2, Rajasekhar Addagatla3
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Posterior urethral valves (PUV) are a common cause of lower urinary tract obstruction in children, potentially leading to end-stage renal disease (ESRD). Early intervention is crucial for managing PUV and improving outcomes.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Anomalies
Background:
- Posterior urethral valves (PUV) represent the most frequent obstructive anomaly of the lower urinary tract in pediatric patients.
- A significant percentage of children with PUV develop end-stage renal disease (ESRD).
Purpose of the Study:
- To elucidate the spectrum of posterior urethral valves (PUV) in children.
- To analyze management strategies and patient outcomes for PUV.
- To identify factors influencing the progression of renal disease in affected children.
Main Methods:
- A retrospective descriptive study reviewed medical records of 73 children diagnosed with PUV between 2015 and 2019.
- Data collected included antenatal ultrasonography findings, age at presentation, clinical symptoms, biochemical markers, interventions, and follow-up outcomes.
- Outcomes assessed included urinary stream improvement, renal function, recurrent urinary tract infections (UTIs), hypertension, and mortality.
Main Results:
- The mean age of presentation for PUV was 3.4 years, with poor urinary stream and dribbling being the most common symptoms.
- Abnormalities were detected on antenatal ultrasonography in 23 patients, and 28 patients presented with abnormal renal function.
- Surgical interventions included endoscopic ablation (51 patients), vesicostomy (19 patients), and supravesical diversion (3 patients). Recurrent UTIs occurred in 11 patients, 15 progressed to chronic kidney disease, and 4% mortality was observed.
Conclusions:
- Posterior urethral valves encompass a range of conditions from mild to severe.
- Prompt surgical relief of obstruction is vital to prevent or postpone the onset of ESRD.
- Timely diagnosis and intervention are critical for improving the long-term prognosis in children with PUV.
Background:
Posterior urethral valves (PUV) are the most common obstructive anomaly of the lower urinary tract in children. End-stage renal disease (ESRD) in 17% of the children is due to PUV. The present study helps know the spectrum of the disease, management options, and the outcome in these children.
Methods:
The present study is a descriptive type of study by review of medical records of all the children presented to the hospital from 2015 to 2019. Profile of PUV includes any abnormality in antenatal ultrasonography (USG), age at presentation, presenting complaints, general condition at the time of presentation, biochemical investigations like serum creatinine and electrolytes at admission, clinical progression during hospital stay and the type of intervention. Outcome variables studied were improvement in the stream and overall well-being of the child, renal function, recurrent urinary tract infections (UTIs). Follow-up period varied from 1 to 6 years.
Results:
A total of 73 patients were included in the study. The mean age of presentation was 3.4 years. The most common presenting complaints were poor urinary stream and dribbling of urine. Antenatal USG showed abnormality in 23 patients. Renal function was abnormal in 28 patients. Out of 73 patients, 51 underwent endoscopic ablation of valves, 19 underwent vesicostomy, and three patients underwent supravesical diversion. During the follow-up recurrent UTI was observed in 11 patients, 15 patients progressed to chronic kidney disease, and 15% of patients were hypertensive. Mortality in the present study was 4%.
Conclusion:
PUV includes a spectrum of diseases from mild form to lethal conditions. Early intervention by relieving obstruction may prevent or delay the ESRD; hence, timely intervention is necessary in these children.
