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[Posterior urethral valve: determining factors of long-term results]
1Great Ormond Street Hospital for Sick Children, Institute of Child Health, University of London.
Insights
Posterior urethral valves (PUV) affect boys, causing kidney and bladder issues. Treatments aim to improve long-term outcomes for renal function and urinary continence.
Area of Science:
- Pediatric Urology
- Congenital Abnormalities
- Nephrology
Context:
- Posterior urethral valves (PUV) represent the most frequent congenital obstruction of urine flow in male infants.
- PUV can lead to significant long-term complications affecting renal function and bladder dynamics.
Purpose:
- To review the antenatal, neonatal, and long-term treatment strategies for posterior urethral valves.
- To discuss the impact of these treatments on the long-term prognosis of patients with PUV.
Summary:
- Impaired renal function (30-50%) with reduced GFR, hyperdiuresis, and acidosis are common long-term sequelae of PUV.
- Bladder dysfunction (75%) including abnormal storage, voiding, and vesicoureteric reflux are prevalent, often leading to incontinence and recurrent UTIs.
- Abnormalities in bladder outlet contribute to incontinence and ejaculatory dysfunction.
Impact:
- Understanding treatment roles is vital for optimizing outcomes in boys with PUV.
- This review highlights the importance of comprehensive management from prenatal diagnosis through long-term care for children with PUV.
Abstract:
Posterior urethral valves (PUV) is the most common congenital urine flow impairment in boys. Long-term prognosis involves: renal function impaired in 30 to 50% of PUV and leading to hyperdiuresis, low GFR and acidosis; bladder urodynamics impaired in 75% of PUV with abnormal urine storage, abnormal micturition and vesicoureteric reflux. Incontinence and recurrent urinary tract infections commonly reflect bladder and renal failures; abnormal bladder outlet leads to incontinence and abnormal ejaculation. The roles of antenatal treatments (vesico-amniotic shunts), neonatal treatments (resuscitation and endoscopic treatment of PUV) and long-term treatments (urinary diversions, bladder augmentation, alpha blockers, anticholinergic, dialysis and renal transplant) in the long-term outcomes of PUV are reviewed.