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Urethral valves during the first year of life--a retrospective, multicenter study
H J Pompino1, R H Bodecker, U A Trammer
1Department of Surgery and Urology, DRK Children's Hospital, Siegen, Germany.
Insights
Early diagnosis of urethral valves in infants significantly impacts outcomes. Delayed diagnosis improves survival and reduces renal insufficiency in children with posterior urethral valves.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- Early diagnosis and treatment are crucial for optimal outcomes, but risk factors and prognostic indicators require further elucidation.
Purpose of the Study:
- To analyze the diagnoses, treatment, and clinical courses of children with posterior urethral valves.
- To identify prognostic risk factors and evaluate the impact of therapeutic procedures on long-term outcomes.
Main Methods:
- Retrospective, multicenter study analyzing data from 178 children with posterior urethral valves.
- Patients were divided into two groups based on age at diagnosis: Group I (within 4 weeks of life) and Group II (2-12 months of life).
- Statistical analysis was performed to identify significant risk factors and compare outcomes between groups.
Main Results:
- Group I (early diagnosis) showed significantly poorer outcomes, including a 10% mortality rate in the first year versus 1% in Group II, and 25% renal insufficiency versus 8.2% in Group II.
- Significant risk factors for poor prognosis included lower birth weight, younger age at diagnosis, impaired renal function (creatinine >200 µmol/L initially, failing to drop below 100 µmol/L post-therapy), and bilateral high-grade vesicoureteral reflux (Grade IV-V).
- Neoimplantation and supravesical urinary diversion did not show statistically significant effects on long-term prognosis.
Conclusions:
- Diagnosis of posterior urethral valves within the first month of life is associated with severe congenital abnormalities and poorer outcomes.
- Age at diagnosis, birth weight, renal function, and vesicoureteral reflux grade are critical prognostic indicators.
- Current therapeutic strategies, including neoimplantation and urinary diversion, did not demonstrate a significant impact on long-term clinical course in this study.
Abstract:
The diagnoses, treatment, and clinical courses of 178 children with urethral valves were analyzed in a retrospective, multicenter study. In group I the diagnosis had been made during the first 4 weeks of life, in group II between the 2nd and 12th months of life, after which treatment was begun. Statistical analysis of the patient data and results revealed clearly poorer results for patients in group I, who had the most severe congenital abnormalities: 10% of the infants in group I died within the 1st year of life as compared to 1% in group II. Among the survivors, 25% of children in group I had renal insufficiency as opposed to 8.2% in group II. The following parameters proved to be statistically significant risk factors with regard to prognosis: 1. Birth weight 2. Age at diagnosis 3. Renal function, particularly when initial creatinine levels exceed 200 mumol/l and fail to decrease below 100 mumol/l after successful therapy 4. Bilateral grade IV or V vesicoureteral reflux 5. Late incontinence (after conclusion of the 5th year of life). Statistical significance could be demonstrated for parameters 1-4, but due to the small number of patients not for parameter 5. The study showed that numerous neoimplantations associated with high complication rates were carried out in both groups, however, no statistically significant effect on long-term prognosis could be established. Our results did not confirm those of the Toronto group, who proposed that broadening the indications for supravesical urinary diversion would provide demonstrable parenchymal protection. No statistically significant relationship between therapeutic procedure and long-term clinical course could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)