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Management of congenital posterior urethral valves
Insights
Congenital posterior urethral valves often lead to kidney damage in infants. Early diagnosis and monitoring of glomerular filtration rate are crucial for predicting recovery and managing potential chronic renal failure.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Congenital posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- PUV can lead to significant upper urinary tract damage, including hydronephrosis and renal failure, if not diagnosed and managed promptly.
Purpose of the Study:
- To present a long-term follow-up of children treated for congenital posterior urethral valves.
- To analyze the incidence of upper urinary tract dilatation and ureteric reflux in relation to diagnosis timing and age.
- To evaluate the impact of surgical management and spontaneous resolution on renal function and upper tract abnormalities.
Main Methods:
- Retrospective review of 46 children diagnosed with congenital posterior urethral valves since January 1972.
- Assessment of upper urinary tract dilatation, ureteric reflux, and renal function (including glomerular filtration rate) at diagnosis and during follow-up.
- Analysis of treatment outcomes, including spontaneous resolution rates and the effect of surgical interventions.
Main Results:
- Most children (52%) were diagnosed within the first 3 months of life, with 93% exhibiting upper urinary tract dilatation and 72% having ureteric reflux at diagnosis.
- Renal failure was present in 72% of all children, and 83% of those diagnosed under 3 months.
- Spontaneous resolution of reflux occurred in one-third of cases, and ureteric dilatation subsided in 57%. Renal function improved in over 60% of those with initial renal failure.
- Glomerular filtration rate <50% of normal at diagnosis accurately predicted persistent chronic renal failure.
Conclusions:
- Congenital posterior urethral valves frequently cause significant renal impairment at diagnosis, particularly in younger infants.
- While spontaneous resolution of reflux and dilatation occurs, prompt diagnosis and monitoring of renal function, especially glomerular filtration rate, are critical for predicting long-term outcomes and managing chronic kidney disease.
Abstract:
A series of 46 children treated by the author since January 1972 for congenital posterior urethral valves is presented: 22% were diagnosed at birth, 28% as neonates and 52% in the first 3 months of life. Ninety-three per cent had unilateral or bilateral dilatation of the upper urinary tract at the time the valves were diagnosed and 72% had ureteric reflux. Unilateral reflux occurred into the left ureter twice as often as the right. Renal failure was present at the time of diagnosis in 72% of all of the children but in 83% of those aged less than 3 months. Surface urinary diversion was used minimally during post-operative management and contributed little to the recovery of renal function. Reflux disappeared spontaneously in one-third of the refluxing ureters. Ureteric dilatation subsided spontaneously in 57% of dilated ureters. Surgery was performed mostly for reflux. Non-refluxing ureteric dilatation was made worse by surgery in a few instances and in others the dilatation improved with time rather than as a result of surgery. Renal function returned to normal in over 60% of the children who were in renal failure at diagnosis. Measurement of glomerular filtration rate was the most accurate method of predicting recovery of renal function: a value of less than 50% of normal for age at the time of diagnosis forecast persistent chronic renal failure with all its attendant complications.