A review of urodynamic evaluation in children and its role in the management of boys with posterior urethral valves

Desai, Divyesh

doi:10.4103/0970-1591.36719

Cited by 17 publications

(12 citation statements)

References 13 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Posterior urethral valves (PUV) are the most common cause of congenital lower urinary tract outflow obstruction in male infants with an incidence of 1:5,000 male infants and 1:25,000 live births. [ 1 2 3 ] The incidence is unknown in our sub-region. Uba et al [ 1 ] in Jos, Nigeria reported 3–8 cases per annum.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

et al. 2015

View full text Add to dashboard Cite

Background:The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV.Materials and Methods:It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed.Results:Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices.Conclusions:The initial treatment outcome was good but most had poor prognostic factors.

show abstract

Section: Introductionmentioning

confidence: 99%

“…The anomaly is associated with considerable morbidity including urosepsis, urinary incontinence (over-flow), chronic renal insufficiency (RI), and even death. [ 2 6 ] Odetunde et al [ 5 ] In Enugu, Nigeria reported that the bulk of patients seen with PUV in their practice presented late with urosepsis, anemia, uremia, and ESRD.…”

Section: Introductionmentioning

confidence: 99%

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Posterior urethral valve (PUV) is the most common lower urinary tract congenital anomaly in boys with an incidence of 1: 5000–1:8000 males [ 1 – 5 ]. It is the leading cause of bladder outlet obstruction and renal insufficiency in male children [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…This result from persistent and unrelieved pressure on the bladder leading to bladder diverticular, hydronephrosis and chronic to end-stage renal diseases (ESRD). The anomaly is associated with high mortality and morbidity including urosepsis, overflow urinary incontinence, chronic kidney diseases (CKD), hypertension, chronic anaemia, failure to thrive, poor quality of life and even death [ 5 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital

et al. 2018

View full text Add to dashboard Cite

BackgroundThe incidence of posterior urethral valve (PUV) is estimated at 1:5000–1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV.MethodsRetrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality.ResultsA total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%.ConclusionMany patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction.

show abstract

“…(3) inherent renal dysplasia; and acquired problems including (4) progressive vesical dysfunction, (5) megaureter with progressive renal scarring, and (6) metabolic and systemic complications [11][12][13].…”

Section: Hypothesis Regarding the Possible Embryological Basis Of Sevmentioning

confidence: 99%

The posterior urethral valves revisited: embryological correlation, clinical classification, and risk stratification of the spectrum

Sarma

2020

Ann Pediatr Surg

View full text Add to dashboard Cite

Background The diagnosis of posterior urethral valves (PUV) encompasses a vast spectrum of disease with variable severity and clinical features. It is vital to understand the extent of developmental insult and to define the different distinct entities grouped together under the diagnostic umbrella of PUV. This would help to determine the severity of the disease, enable better prognostication, and optimize therapy. The objective of this study is to analyze the variable features of PUV and correlate the different manifestations with the embryological development of the urinary system. The possible developmental basis of anomalies in PUV is analyzed, as recognition of the underlying defect would help to determine the severity of the disease. A clinical classification and a risk stratification approach encompassing the spectrum of PUV is proposed, to help define diagnosis and guide prognosis. A combined retrospective and prospective analysis of cases diagnosed as PUV at the tertiary teaching institute over a 5-year period from July 2014 to July 2019 was done. The outcome of selected cases was analyzed, based on the risk group stratification. Results The incidence of major complications during follow-up in each risk group was assessed individually and found to be highest in the high-risk group (92%), which was significantly higher than the other groups. The intermediate risk group was found to have a complication rate of 38%, while the low-risk group had only 12.5% complication rate. The three key concepts addressed in this study pertain to the embryological basis of PUV, the necessity of a clinical subdivision of patients, and the possibility of risk stratification based on clinical criteria. The limited review of institutional series is added to highlight the method of risk stratification and its probable utility. Conclusions The most critical factors to be accounted for in the diagnosis and management of PUV are the definition of disease severity, recognition of systemic complications, and identification of children at risk of progression to ESRD. The proposed developmental defect analysis, description of PUV sequence, clinical classification, and risk stratification approach are only the means to this end of segregating patient groups within the diagnostic spectrum.

show abstract

A review of urodynamic evaluation in children and its role in the management of boys with posterior urethral valves

Cited by 17 publications

References 13 publications

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital

The posterior urethral valves revisited: embryological correlation, clinical classification, and risk stratification of the spectrum

Contact Info

Product

Resources

About