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Defining post-obstructive diuresis following posterior urethral valve ablation.

Callum Lavoie1, Brian Chun1, Christine Do1

  • 1Division of Urology, Children's Hospital Los Angeles, USC Institute of Urology, Keck School of Medicine of USC, Los Angeles, CA, United States.

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Neonates with posterior urethral valves (PUV) experiencing high urine output after valve ablation are at increased risk for prolonged hospital stays. A 24-hour urine output threshold of 3.5 mL/kg/h may help identify patients at risk for post-obstructive diuresis.

Keywords:
pediatric urologypost-obstructive diuresisposterior urethral valvesurethral valve ablationurinary obstruction

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Area of Science:

  • Pediatric Urology
  • Neonatal Critical Care
  • Nephrology

Background:

  • Posterior urethral valves (PUV) are a common cause of congenital lower urinary tract obstruction in neonates.
  • Management of PUV can lead to post-obstructive diuresis (POD), potentially complicating patient recovery and hospital course.
  • Identifying neonates at high risk for POD is crucial for optimizing care, yet data is limited.

Purpose of the Study:

  • To define an initial urine output (UOP) threshold for identifying neonatal post-obstructive diuresis (POD) following posterior urethral valve (PUV) ablation.
  • To investigate the correlation between post-ablation urine output and hospital length of stay (LOS).

Main Methods:

  • Retrospective chart review of neonates undergoing cystoscopic valve ablation for PUV between 2004 and 2019.
  • Analysis of urine output at 4- and 24-hours post-ablation, alongside serum creatinine, electrolytes, and fluid intake.
  • Logistic regression models were used to assess predictors of prolonged hospital stay.

Main Results:

  • Forty patients met inclusion criteria; mean age at ablation was 11.2 days.
  • Post-operative mean urine output was 4.2 ± 3.7 mL/kg/h at 4 hours and 4.5 ± 2.2 mL/kg/h at 24 hours.
  • A 24-hour UOP > 3.5 mL/kg/h was associated with over 5 times the odds of a prolonged hospital stay (>3 days) (OR: 5.50).

Conclusions:

  • Neonates with PUV undergoing valve ablation are susceptible to POD.
  • Elevated urine output post-ablation is a significant predictor of increased hospital length of stay.
  • A 24-hour UOP threshold of >3.5 mL/kg/h can serve as an initial indicator for defining POD after PUV ablation.