Prognostic factors of posterior urethral valves and the role of antenatal detection

Abstract

The aim of the study was to investigate the significance of different prognostic factors and long-term renal outcome in boys with posterior urethral valves (PUVs) detected either antenatally or during infancy. A total of 46 cases of PUVs, 23 antenatal and 23 postnatal, were followed prospectively from 1983 to 2003. The mean follow-up time was 12.5 years. The impact of vesicoureteral reflux (VUR), urinary tract infections (UTIs), urinary continence, and renal parenchymal damage on patient outcome was evaluated. Long-term renal outcome was defined as favorable if renal function was either normal or moderately impaired (glomerular filtration rate > or = 60 ml/min per 1.73 m(2)) and poor if the patient had either chronic renal failure or end-stage renal disease. The outcome was poor in 14 (30%) of the 46 boys and was associated with a significantly higher nadir serum creatinine concentration (mean 157 micromol/l) during the 1st year of life ( P<0.001), with bilateral VUR ( P<0.05) and breakthrough UTIs ( P<0.05). In our patients, age at achieving urinary continence, and the presence of renal parenchymal damage did not have a statistically significant association with long-term renal outcome. The long-term outcome among boys with antenatally detected PUVs did not differ from that among those cases detected postnatally after developing symptoms ( P=0.25).

The Percutaneous shunting in Lower Urinary Tract Obstruction (PLUTO) study and randomised controlled trial: evaluation of the effectiveness, cost-effectiveness and acceptability of percutaneous vesicoamniotic shunting for lower urinary tract obstruction

“…However, recent registry data from Finland 68 have presented outcomes in babies with PUVs (n = 46), with 23 diagnosed prenatally (with no intervention) and 23 diagnosed postnatally (with apparently 'normal' ultrasound appearances in the majority). This cohort study is unique, in that long-term follow-up over 10 years was performed (mean 12.5 years, range 5.5-20.1 years).…”

“…Some researchers who have studied these patients prospectively have reported significant renal morbidity (notably end-stage renal failure requiring dialysis or transplantation) 68 and others have found acceptable quality-of-life scores in a majority in the long term. 83 Such data, which will be useful in understanding the overall cost-effectiveness of VAS, are not currently available from the PLUTO trial and hence were not included in this analysis.…”

Congenital Obstructive Nephropathy: Clinical Perspectives and Animal Models

“…The authors of the latter study note that for the more severely affected patients, the functional outcome may be primarily determined by the severity of intrauterine obstruction and presence of renal dysplasia and not significantly altered by early diagnosis and treatment; however, for patients with more moderate disease, long-term prognosis may be improved by prenatal diagnosis and early interventions (Kousidis, et al, 2008). Other studies have not shown a statistically significant difference in outcomes between patients with renal dysplasia and those with normal-appearing kidneys (Nickavar, et al, 2008;Ylinen et al, 2004).…”

Risk factors for renal insufficiency in children with urethral valves

“…Obstructive uropathy, renal hypoplasia, and dysplasia constitute 39% of the cases of end stage kidney disease (ESKD) in childhood in Germany, including the cases of boys with PUV [5]. The incidence of ESKD in children with PUV varies between 13 and 38% [6,7]. Results from previous studies imply a variety of prognostic factors for the development of ESKD, including creatinine concentration, bilateral or persistent vesicoureteral reflux (VUR), delayed diagnosis, poor detrusor function, delayed achievement of urinary continence, oligohydramnios, ventilatory support after birth, and breakthrough urinary tract infections [7][8][9][10][11][12][13][14].…”