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Posterior Urethral Valves at the University College Hospital Ibadan: A Seven-Year Review
A D Ademola1,2, A O Asinobi1,2, D I Olulana3,4
1Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria.
Insights
Posterior urethral valve (PUV) is a common cause of severe urinary obstruction in boys, leading to significant morbidity and mortality, especially in low-resource settings. Early detection and treatment are crucial for improving outcomes in pediatric patients with PUV.
Area of Science:
- Pediatric Urology
- Nephrology
- Public Health
Background:
- Posterior urethral valve (PUV) represents the most frequent severe obstructive uropathy in pediatric males.
- Understanding the presentation, management, and outcomes of PUV is essential for improving patient care.
Purpose of the Study:
- To provide an updated analysis of patients diagnosed with posterior urethral valve (PUV) within a specific hospital setting.
- To evaluate the clinical presentation, treatment strategies, and patient outcomes for PUV.
Main Methods:
- A retrospective study was conducted on patients diagnosed with PUV between January 1, 2016, and December 31, 2022.
- Data collected included patient demographics, clinical presentation, management interventions, and outcomes such as kidney function and mortality.
Main Results:
- Fifty-one patients were analyzed, with a median age of 1.3 years for those not previously treated and 6.4 years for those with prior valve ablation.
- Common presentations included voiding symptoms (45.5%), abdominal swelling (40.9%), and fever (38.6%). Wasting affected 43.9% of patients.
- The study reported a 19.6% mortality rate, primarily due to sepsis and end-stage kidney disease (ESKD).
Conclusions:
- Posterior urethral valve (PUV) is a significant contributor to morbidity and mortality in resource-limited environments.
- Improving outcomes necessitates enhanced antenatal detection, prompt diagnosis and treatment, and increased access to kidney transplantation.
Background:
Posterior urethral valve (PUV) is the most common severe obstructive uropathy in boys. We reviewed patients with PUV in our hospital to provide an update on the presentation, management and outcome of PUV in our setting.
Methodology:
A retrospective study of patients with PUV admitted in our hospital between January 1, 2016 - December 31, 2022.
Results:
Fifty-one patients were included, seven (median age 6.4 IQR 2.3, 10.8 years) had undergone valve ablation before presentation, while 44 (median age 1.3 IQR 0.1, 2.9 years) had not. Among the 44, four (9.1%) had abnormal features on antenatal ultrasound. 15.9% and 56.9% presented in the neonatal period and after one year of age respectively. The main complaints were voiding symptoms (45.5%), abdominal swelling (40.9%) and history of fever (38.6%). Wasting occurred in 43.9%. Serum creatinine ranged from 0.2-25.5 (median 1.4, IQR 0.8-3.0) mg/dl. Thiry seven children underwent valve ablation. Additionally, four of the 51 patients underwent repeat valve ablation. End-stage kidney disease (ESKD) occurred in five (9.8%). Dialysis was carried out in six patients (11.7%) including two patients with acute kidney injury. None underwent kidney transplantation. Mortality occurred in 10 (19.6%) and was due to sepsis (n=5) and ESKD (n= 4).
Conclusion:
Posterior urethral valve is an important cause of morbidity and mortality in low resource settings and has 19.6% mortality in our centre over a 7-year period. Enhanced access to antenatal detection, early diagnosis and treatment, and kidney transplantation have the potential to improve outcomes.
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