Delayed presentation in posterior urethral valve: long-term implications and outcome

Abstract

Objectives: To analyze the effect of delayed presentation of posterior urethral valves in children.

Methods: We divided 194 children with posterior urethral valve (PUV) who underwent surgical ablation into group I (less than 2 years old) and group II (greater than 2 years old) according to age at presentation. We analyzed the data for the effect of various parameters on post-valve fulguration long-term outcomes.

Results: Groups I and II had 95 and 99 children, respectively. Poor urinary stream or crying during micturition was the most common presenting complaint (96%) in both groups. A total of 32.6% and 81.8% patients had azotaemia at the time of diagnosis in groups I and II, respectively (P <0.001). Mean serum creatinine was 1.68 mg% and 4.1 mg% in groups I and II, respectively (P <0.05). Primary valve ablation was performed in 85.5% patients. After valve ablation, voiding improved in 86.1% and 20.4% patients in groups I and II, respectively (P = 0.001). At a mean follow-up of 9.8 years, 30.5% and 40.8% patients developed renal insufficiency in groups I and II, respectively (P <0.05). Serum creatinine level at 1 year after valve ablation and at presentation was the main prognostic factor for groups I and II, respectively, whereas persistence of VUR and voiding dysfunction after valve ablation reflected poor prognosis for both groups.

Conclusions: Patients with PUV presenting after 2 years should be treated with caution because the condition is potentially hazardous and these patients are at a higher risk of developing chronic renal insufficiency on long-term follow-up.