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. 2019 Nov-Dec;60(6):306-311.
doi: 10.4103/nmj.NMJ_118_18. Epub 2020 Feb 24.

Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves

Abdulrasheed A Nasir  1 , Adewale O Oyinloye  1 , Lukman O Abdur-Rahman  1 , Kayode T Bamigbola  2 , Nurudeen T Abdulraheem  1 , Olanrewaju T Adedoyin  3 , James O Adeniran  1
Affiliations

Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves

Abdulrasheed A Nasir et al. Niger Med J. 2019 Nov-Dec.

Abstract

Background: Posterior urethral valve (PUV) is a significant cause of morbidity and mortality among male children resulting in renal failure in 25%-30% before adolescence irrespective of initial treatment. This study aimed at evaluating the early outcomes of children managed for PUV.

Materials and methods: This was a prospective study of all children who were treated for PUV between 2012 and 2016 at a single referral institution. Information reviewed included demographic and clinical data, imaging findings, pre- and post-operative serum electrolytes, and postoperative renal outcomes.

Results: Twenty-nine male children were managed for PUV at a median age of 6 months including 7 (24.1%) neonates. Two (6.9%) patients had antenatal diagnosis. Micturating cystourethrogram confirmed PUV in all patients. Fourteen (48.3%) patients had impaired renal function (IRF) at presentation and 8 (57%) had improved renal function (RF) after initial catheter drainage. The mean creatinine at presentation was 1.86 ± 1.69 mg/dl and the mean serum creatinine following initial catheter drainage was 0. 93 ± 0.49 mg/dl (P = 0.003). For those patients with normal RF, the mean creatinine at presentation was 0.81 ± 0.22 mg/dl versus 0.74 ± 0.21 mg/dl (P = 0.012), following initial catheter drainage. Children with IRF on admission had mean creatinine at presentation of 2.61 ± 2.00 mg/dl compared to 1.17 ± 0.53 mg/dl (P = 0.002) after initial catheter drainage. Valve ablation was achieved with Mohan's valvotome in 26 (96.3%) patients. All patients had good urine stream at a median follow-up of 5 months. Four (13.8%) patients developed IRF at follow-up. Renal outcomes of patients presenting before 1 year and those presenting after 1 year were similar. Two children died preoperative of urosepsis and one out of hospital death given an overall mortality of 10.3% (n = 3).

Conclusion: There was significant improvement in RF after initial catheter drainage. The incidence of IRF at follow-up was 13.8%. Long-term follow-up is necessary to identify patients at risk of end-stage renal disease.

Keywords: Congenital obstructive posterior urethral membrane; posterior urethral valves; renal impairment; vesicoureteric reflux.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Micturating cystourethrogram of a child with posterior urethral valve demonstrating elongated and dilated posterior urethral, and irregularity of the bladder wall from trabeculations
Figure 2
Figure 2
(a) Urethrocystoscopic view of a child with posterior urethral valve demonstrating obstructing posterior urethral valve arising from verumontanum, Type 1, (b) Urethrocystoscopic view after valve ablation showing torn valves
See this image and copyright information in PMC

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