Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Sep;40(9):2181-2194.
doi: 10.1007/s00345-022-04097-x. Epub 2022 Aug 9.

Comparison of outcomes of prenatal versus postnatal presentation of posterior urethral valves: a systematic review and meta-analysis

Priyank Yadav  1   2 , Mandy Rickard  1 , Jin Kyu Kim  1   3 , Juliane Richter  1 , Marisol Lolas  1 , Dheidan Alshammari  1 , Michael E Chua  1   4 , Joana Dos Santos  1 , Armando J Lorenzo  5   6
Affiliations
Meta-Analysis

Comparison of outcomes of prenatal versus postnatal presentation of posterior urethral valves: a systematic review and meta-analysis

Priyank Yadav et al. World J Urol. 2022 Sep.

Abstract

Objective: To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes.

Methods: We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible.

Results: The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias.

Conclusion: The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.

Keywords: ESRD; PUV; Postnatal detection; Prenatal diagnosis; RRT.

PubMed Disclaimer

References

    1. Heikkilä J, Holmberg C, Kyllönen L, Rintala R, Taskinen S (2011) Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol 186(6):2392–2396 - PubMed - DOI
    1. Engel DL, Pope JC, Adams MC, Brock JW, Thomas JC, Tanaka ST (2011) Risk factors associated with chronic kidney disease in patients with posterior urethral valves without prenatal hydronephrosis. J Urol 185(6S):2502–2506 - PubMed - DOI
    1. Kilby MD, Morris RK (2014) Fetal therapy for the treatment of congenital bladder neck obstruction. Nat Rev Urol 11(7):412–419 - PubMed - DOI
    1. Van Mieghem T, Ryan G (2013) The PLUTO trial: a missed opportunity. Lancet 382(9903):1471–1473 - PubMed - DOI
    1. Morris RK, Malin GL, Quinlan-Jones E, Middleton LJ, Hemming K, Burke D et al (2013) Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet 382(9903):1496–1506 - PubMed - PMC - DOI

LinkOut - more resources