Outcomes of primary valve ablation versus urinary tract diversion in patients with posterior urethral valves

Farhat, Walid A.; McLorie, Gordon A.; Capolicchio, Gianpaolo; Khoury, Antoine E.; Bägli, Darius; Merguerian, Paul A.

doi:10.1016/s0090-4295(00)00784-6

Cited by 59 publications

(36 citation statements)

References 11 publications

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“…Potentially, sodium chloride supplementation in the PUV patients without dRTA could have boosted their growth velocities; however, an insignificant association between the baseline natriuresis and Δ height SDS did not support this notion. Understandably, an antenatal diagnosis would have helped with early diagnosis; a similar diagnosis delay and comparable age pattern have also been observed in other studies on postnatally diagnosed PUV [29,30].…”

Section: Discussionsupporting

confidence: 78%

Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

et al. 2009

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Incomplete distal renal tubular acidosis (idRTA) has recently been associated with osteoporosis and growth retardation, attributed to the mild persistent metabolic acidosis. We hypothesized a therapeutic benefit from bicarbonate therapy on growth parameters in children with idRTA. In a study group of 40 surgically treated patients with posterior urethral valve (PUV) and normal estimated glomerular filtration rate, we evaluated the change in height standard deviation scores (SDSs) while they were on bicarbonate therapy in the presence of idRTA and complete distal renal tubular acidosis (dRTA). Age- and gender-matched healthy subjects constituted the control group (n = 55). Incomplete dRTA was evaluated by ammonium chloride acidification. The baseline height SDS of -1.94 +/- 0.41 and -5.31 +/- 1.95 in the groups with idRTA and complete dRTA, respectively, were significantly lower than that of the controls. After a follow-up period of 24.7 +/- 8.3 months on sodium bicarbonate therapy, the idRTA patients had a 66% increase in height SDS compared with 26% and 3% increases in the patients with PUV with complete dRTA and without dRTA, respectively. At the end of follow-up, mean height SDS in the group with idRTA no longer remained significantly lower than that of the controls (P = 0.42). We concluded that bicarbonate therapy improves height SDS in idRTA. This issue needs further validation in larger studies.

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Section: Discussionsupporting

confidence: 78%

Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

et al. 2009

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“…The role of urinary diversion is still on debate. Farhat et al [24] concluded that prenatal and postnatal factors such as renal dysplasia and urinary tract infection rather than valve treatment dictate the long-term outcomes. Still, PUVs are the most common cause leading to childhood renal failure, independent of prenatal diagnostics and therapeutic options [25,26] .…”

Section: Postnatal Diagnostics and Therapymentioning

confidence: 99%

Posterior Urethral Valves: Prenatal Diagnostic Signs and Outcome

Eckoldt

Woderich²,

Wolke³

2004

Urol Int

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Introduction: Urethral valves can be of enormous clinical importance. Both the prognosis for an affected fetus and the indication for a prenatal therapeutic intervention depend to a high degree on the accuracy of the prenatal diagnosis. Patients and Methods: The sonographic findings and the results of the postnatal diagnostic workup of 24 boys treated for urethral valves in our institute are analyzed in the present paper. Results: Out of a group of 900 children, diagnosed prenatally as having urinary tract anomalies, the postnatal diagnostic workup revealed 24 boys suffering from posterior urethral valves. The combination of megacystis, oligohydramnios, and bilateral renal abnormalities was present in 3 boys, and it was only in these cases that urethral valves were correctly identified as the underlying pathology. The largest group (n = 16) of these fetuses presented with bilateral hydronephrosis with and without megaureter. Megacystis in any combination with other findings was detected only in 4 patients. Oligohydramnios as a sign of impaired renal function was observed in four pregnancies. Four children suffered postnatally from beginning renal insufficiency. Eight infants (33%) required some form of respiratory support. This group included the 4 newborns with oligohydramnios during the pregnancy. Conclusions: Posterior urethral valves represent a rare but severe congenital malformation. They can disrupt the development of the entire urinary tract and may be life-limiting to the affected boy. Only rarely, however, are they manifested as the complete pathological picture on prenatal ultrasound. In most cases, bilateral impairment of the fetal renal development suggests severe subvesical obstruction. Thus in cases with bilateral renal impairment on prenatal ultrasonography, posterior urethral valves are to be excluded postnatally. Oligohydramnios is a predictor of a poor outcome of the renal function.

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“…[18] Studying 50 cases, not surprisingly, they found that 22 patients born with normal upper tracts with normal biochemistry remained normal at 3 years following valve fulguration. Of those with normal renal function but upper tract dilatation and or reflux, 50% had normalisation of the upper tracts.…”

Section: Renal Functionmentioning

confidence: 97%

Posterior urethral valves: The value of high diversion

MacKinnon

2005

J Indian Assoc Pediatr Surg

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ABSTRACT ABSTRACT ABSTRACTThe management of posterior urethral valves remains a challenge to the paediatric urologist. Many cases diagnosed early may be managed by endoscopic surgery. However, where there is a gross upper tract dilatation, consideration needs to be given to temporary diversion to allow recovery of renal function and the elimination of infection. Western literature leans strongly towards nondiversion. However, in those countries, most patients present early, and often by antenatal diagnosis. Countries not having universally, highly developed medical services encounter more of the complicated cases. Evaluation of the role of upper tract diversion in such circumstances has not been conclusively established, but literature review indicates a role in selected cases.

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Outcomes of primary valve ablation versus urinary tract diversion in patients with posterior urethral valves

Cited by 59 publications

References 11 publications

Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

Bicarbonate therapy improves growth in children with incomplete distal renal tubular acidosis

Posterior Urethral Valves: Prenatal Diagnostic Signs and Outcome

Posterior urethral valves: The value of high diversion

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