Outcome of Prenatally Diagnosed Posterior Urethral Valve Patients—Experience from a Low Income Country (original) (raw)
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Prenatal Diagnosis, 2016
ObjectiveThe objective of the study was to evaluate prenatal sonographic signs that distinguish male fetuses with posterior urethral valves (PUV) from those with vesicoureteral reflux (VUR).MethodsPrenatal data were retrospectively retrieved from all consecutive women delivering between 2003 and 2012 of a male newborn with a postnatal diagnosis of PUV or VUR. Prenatal parameters included fetal bladder characteristics, identification of a dilated posterior urethra, and change in shape and size in the fetal renal pelvis or ureter.ResultsOne hundred thirty‐six women gave birth to a male newborn with a postnatal diagnosis of PUV (n = 49) or VUR (n = 87). The presence of posterior urethral dilatation [21 (42.9%) fetuses versus 0 (0%), p = 0.000], a thickened fetal bladder wall [37 (75.5%) vs 4 (4.6%), p = 0.000], and anhydramnios [14 (28.6%) vs 0, p = 0.000] were strongly associated with the postnatal diagnosis of PUV. Change in shape and size in the fetal renal pelvis or ureter was obse...
International braz j urol
Purpose: Posterior urethral valves (PUVs) are the most common cause of congenital bladder obstruction in boys. Our aim was to assess the impact of early diagnosis and fulguration of PUVs on bladder function and compare their functional and urodynamic outcome with children who underwent delayed intervention. Materials and Methods: We retrospectively evaluated 153 patients who underwent primary valve ablation from two tertiary hospitals between 2001 and 2018. Patients have been divided into 2 groups, group 1 included 69 patients who were detected antenatally and underwent early fulguration of PUVs while group 2 included 84 children presented postnatally and underwent delayed valve ablation. The recorded data throughout followup in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated and compared. Results: Median age at time of valve ablation was 10 days in group 1 and 7 months in group 2. The median follow-up period was 6.5 and 7 years in group 1 and 2, respectively. Chronic kidney disease (CKD) developed in 15 (22%) boys in group 1 while in group 2 it was observed in 31 (37%), p=0.04. While Q-max, mean bladder capacity and post-void residual (PVR) volumes were comparable in both groups, percent PVR was signifi cantly higher in group 2 (3.27 vs. 1.44, p=0.002). Detrusor overactivity was slightly different in both groups (p = 0.07). Conclusions: Compared to delayed intervention, primary ablation of PUVs during the early neonatal life possibly provides the optimum chance to have optimum renal function without impact on bladder function.
Posterior urethral valves: comparison of clinical outcomes between postnatal and antenatal cohorts
Journal of Pediatric Urology, 2018
Background: Posterior urethral valves (PUVs) constitute the most common infravesical urinary obstruction in boys and are often accompanied by severe consequences to the lower and upper urinary tract. Currently, about two-thirds of diagnosis of PUVs has been suspected by prenatal US findings. The aim of this study was to compare long-term clinical outcomes in two groups of patients with PUVs, with antenatal vs. postnatal diagnosis. Study design: Retrospective cohort study of 173 patients with PUVs systematically followed up in tertiary center. Median follow-up time was 66.5 months (Interquartile range, IQ, 11.4-147.9 months) for those patients who survived neonatal period. Seventy-nine (45.6%) patients were followed up for more than 5 years and 55 (32%) for more than 10 years. For analysis, the cohort was stratified into two groups according to the clinical presentation (prenatal vs. postnatal). The events of interest were urinary tract infection (UTI), surgical interventions, proteinuria, hypertension, chronic kidney disease (CKD), and death. Survival analyses were performed to evaluate time until occurrence of the events. Results: Sixty-two patients (35.8%) were diagnosed by fetal sonography. Patients of postnatal group presented a higher incidence rate of UTI episodes (6.5, 95%CI, 4.9-8.3) as compared with antenatal group (1.2, 95%CI, 0.4-2.7) (P<0.001). Thirty-six patients (21%) presented hypertension and 77 (44.5%) had persistent mild proteinuria. There was no significant difference in the estimated incidence of hypertension (P = 0.28) and proteinuria (P = 0.78) between antenatal and postnatal groups. The cumulative incidence of CKD stage ≥ 3 was estimated of about 37% at 10 years age, and 56% at 18 years age. By survival analysis, there was no significant difference in the estimated incidence of CKD stage ≥ 3 (Log-rank=0.32, P = 0.57) and CKD stage 5 (Log rank= 1.08, P = 0.28, Figure) between antenatal and postnatal groups. Of 173 patients included in the analysis, 13 (7.5%) died during followup with a median age of 2.6 months (IQ, 15 days-62 months).
2020
Background and purpose: Posterior urethral valve (PUV) is one of the most s evere urinary tract anomalies presenting as antenatal hydronephro sis that could lead to severe dilatation and functional impairment of one or both kidneys. The a im of this study was to analyze our experience on patients with a diagnosis of PUV. Materials and Methods: In this prospective study neonates with a diagnosis f PUV were enrolled. The patients were assessed clinically for gr wth and hypertension and other clinical complaints specially voiding dysfunctions. Urinary tract ultrasonography study, functional renal scan, and voiding cystourethrography performed peri odically. The patients were assessed for occurrence of hypertension, growth disturbances, lo ng term urinary tract dilatation, persistence of vesicoureteral reflux (VUR), recurrent urinary t act infection (UTI), nephrolithiasis, voiding dysfunction, scar formation chronic renal failure ( CRF) and finally death . Results: A total of 24 childre...
ANTENATAL DIAGNOSIS OF POSTERIOR URETHRAL VALVE: A CASE REPORT.
The posterior urethral valve (PUV) is the most frequent cause of end-stage renal disease in male children. The echographic appeals that may suspect this malformation are variable. We report the case of a 33 year old patient, without a specific antecedent. In whom the T1 ultrasound screening reveals an aspect of megavessy with renal dilation. The T2 ultrasound shows an enlarged bladder with a thickened wall. Both kidneys have a visible cortex, abnormal echostructure marked by bilateral ureter-pyelo-calicial dilatation. Amniotic fluid index is normal. The T3 Ultrasound reveals a persisting bilateral ureter-pyelo-calcicial dilatation and a large bladder with thick walls. The Delivery was natural at 37 SA + 5J and the development of the baby was normal.
BJU International, 2008
Purpose: Management of posterior urethral valves is significantly modified by the prenatal diagnosis. Our aim was to assess long-term outcome of children with prenatally detected posterior urethral valves treated at our institution by primary valve ablation without routine urinary drainage or diversion. Materials and Methods: A total of 79 cases of posterior urethral valves were detected prenatally at our hospital between 1987 and 2004. Of these cases 65 were managed postnatally, while pregnancy was terminated in 14. We studied the prenatal parameters of gestational age at diagnosis, renal parenchyma on ultrasound and amniotic fluid volume. Fetal urine was analyzed when indicated. Long-term outcome was assessed. Results: Primary valve ablation was done in all cases except 2. Median followup was 6.8 years (range 1 to 14.3). At the end of followup there were 11 cases of renal failure (17%) with 5 detected before 24 weeks of gestation, 6 cases of oligohydramnios and 9 cases of abnormal parenchyma. Gestational age at diagnosis and oligohydramnios were statistically significant predictors of final renal outcome (p ϭ 0.003 and p ϭ 0.02, respectively), while renal parenchymal changes were not (p ϭ 0.23). When fetal urinalysis detected good prognosis (12 cases) renal failure developed in none, compared to 2 of the 3 cases with a bad prognosis. Continence was achieved in 42 of 55 toilet trained children (76%), 3 had nocturnal enuresis and 10 (18%) were incontinent. Conclusions: Our long-term results of prenatally detected posterior urethral valves confirm that early valve ablation can be considered as the primary treatment in the majority of patients, without the need for preoperative drainage or diversion. Gestational age at diagnosis and volume of amniotic fluid are significant predictors of postnatal renal outcome.
Canadian Association of Radiologists Journal, 2009
Purpose To review the association of an abnormal prenatal sonogram with most recent serum creatinine in patients with proven posterior urethral valves (PUV). Methods Since 1992, all live-born patients between 1992–2004 with clinically proven PUV, with postnatally proven PUV, from 2 pediatric tertiary care centers, were reviewed for age at diagnosis, most recent serum creatinine, presence of chronic renal failure (CRF) (serum creatinine >2 standard deviations above normal for age), or end stage renal disease (dialysis or transplant). Available antenatal reports from the 2 centres and surrounding community hospitals were reviewed for gestational age (GA) at the time of ultrasound, volume of amniotic fluid, and urinary-tract abnormality. Results Thirty-four patients with proven PUV and prenatal sonograms were identified (1992–2004). Eighteen patients had abnormalities on their prenatal sonogram, with poor outcome in 5 (mean follow-up, 8 years [1–13 y]). No specific features were ide...