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Posterior urethral valves. Does prenatal diagnosis influence prognosis?
L D Jee1, A M Rickwood, R R Turnock
1Regional Department of Paediatric Urology, Royal Liverpool Children's Hospital, Alder Hey.
British Journal of Urology
|November 1, 1993
Summary
Prenatal diagnosis of posterior urethral valves (PUV) often indicates early renal impairment. However, antenatal detection would benefit less than 20% of postnatal PUV cases, suggesting limitations in prenatal screening.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- The impact of prenatal diagnosis on the long-term prognosis of PUV remains an area of interest.
Purpose of the Study:
- To assess the prognostic significance of prenatal ultrasonography in boys diagnosed with posterior urethral valves.
- To evaluate the relationship between diagnostic timing (prenatal vs. postnatal) and renal function outcomes.
Main Methods:
- Retrospective review of 48 boys with posterior urethral valves.
- Analysis of diagnostic method (prenatal ultrasonography vs. postnatal presentation).
- Correlation of renal function, presence of maternal oligohydramnios, and vesicoureteric reflux with diagnostic timing and outcomes.
Main Results:
- Fifty-nine percent of prenatally diagnosed PUV cases presented with impaired renal function before treatment.
- Maternal oligohydramnios was associated with a poor prognosis and persistent renal impairment.
- Antenatal detection would have been beneficial in less than 20% of postnatal PUV cases, even with normal late-pregnancy fetal ultrasounds.
Conclusions:
- While prenatal diagnosis of PUV can identify infants with early renal impairment, it does not guarantee a better prognosis in all cases.
- Maternal oligohydramnios is a significant indicator of poor outcome in PUV.
- Current prenatal screening strategies may miss a substantial proportion of PUV cases that could benefit from earlier detection.