Posterior Urethral Valves: Experience of a Level III Hospital
Keywords:Child, Urethra/abnormalities, Urethral Diseases, Urethral Obstruction
Introduction: The posterior urethral valves (PUV) are an important cause of congenital urinary tract obstruction affecting male children. Our aim in this study was to characterize the evolution of a children group with PUV with identification of possible risk factors to chronic kidney disease (CKD).
Methods: Retrospective analysis of PUV children diagnosed between January 1999 and January 2017 in a level III hospital. Data collected included: clinical, analytical and imagiological findings, treatment and evolution. Statistical tests were realized using: Excel 2016® e Epi Info 7®, with p < 0.05 considered significant.
Results: During the studied period, we identified 23 cases of VUP. The diagnosis was prenatal in 16 and four of seven were diagnosed before age one. The clinical presentation was: acute renal failure (n= 11), isolated urinary tract infections (UTI) (n= 4) and poor urinary stream (n= 3). Median creatinine was 151 μmol/L. All 23 children presented renal and upper urinary tract dilatation, (bilateral in 22), 21 had parenchymal changes and 19 had thickened wall bladder. Cistouretrography confirmed the diagnosis and revealed vesicoureteral reflux (VUR) in 15 cases, bilateral in 10. The main treatment was valve ablation by endoscopic fulguration, performed in all cases, one of them with a previous vesicostomy. The mean follow-up was 7.5 years. During that time, 14 presented recurrent UTI’s, seven remained with VUR and 11 with bladder dysfunction. Some needed other surgical procedures, like VUR correction (n= 3) and unilateral nephrectomy (n= 2). Five cases (21.5%) presented CKD stage ≥ 3, with four cases needing dialysis around 9.3 years of mean age. The recurrent UTI’s and bilateral VUR were associated with evolution to that stage (p 0.03 and p 0.049 respectively).
Conclusion: PUV remains a frequent aetiology of CKD, despite timely and accurate diagnosis and treatment.
2. Mirshemirani A, Khalghnejad A, Rouzrokh M, Sadeghi A, Mohajerzadeh L, Sharifian M. Posterior urethral valves: a single center experience. Iran J Pediatr. 2013;23:531-5.
3. Heikkila J, Holmberg C, Kyllonen L, Rintala R, Taskinen S. Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol. 2011;186:2392-6. doi: 10.1016/j.juro.2011.07.109.
4. Bilgutay AN, Roth DR, Gonzales ET, Jansen N, Zhang W, Koh CJ, et al. Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol. 2016;12:179.e1-7. doi: 10.1016/j.jpurol.2015.10.009.
5. Improving Global Outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2013; 3: 1–150.
6. Hochart V, Lahoche A, Priso RH, Debarge VH, Bassil A, Sharma D, et al. Posterior urethral valves: are neonatal imaging findings preditive of renal function during early childhood? Pediatr Radiol. 2016;46:1418-23. doi: 10.1007/s00247-016-3634-7.
7. Palácios A, Castro R, Cavadas V, Reis A. Válvulas da uretra posterior: Casuística do Serviço de Urologia do Hospital Maria Pia. Acta Urol Port. 2006; 23: 41-6.
8. Coleman R, King T, Nicoara CD, Bader M, McCarthy L, Chandran H, et al. Nadir creatinine in posterior urethral valves: How high i slow enough? J Pediatr Urol. 2015;11:356.e1-5. doi: 10.1016/j.jpurol.2015.06.008
9. Sarhan OM, El-Ghoneimi A, Helmy TE, Dawaba MS, Ghali AM, Ibrahiem EI.