Predictors of the Late Renal Outcome after Posterior Urethral Valves Ablation in a Developing Country: Long Term Study
Iranian Journal of Pediatric Surgery,
Vol. 6 No. 1 (2020),
11 August 2020
,
Page 19-29
https://doi.org/10.22037/irjps.v6i1.31699
Abstract
Introduction: Posterior urethral valves are the commonest form of obstructive uropathy in pediatrics and a common cause of chronic kidney disease (CKD) during childhood with estimated renal failure rate of 25-40%. This study aims at evaluating long term changes in kidney and bladder functions of children with posterior urethral valves after ablation, and at assessing predictors of late renal outcome, considering challenges in Egypt as a developing country. Materials and Methods: A retrospective study of 30 surgically managed PUVs patients who attended at Alexandria University Children’s Hospital for follow up. Patients underwent surgery between 2005 and 2016. Mean postoperative follow up period was 6.7±3.8 years (range 3.1 to 14.6 years). Data collected included age at presentation, clinical presentation, serum creatinine (initial, nadir, and last follow up), eGFR at last follow up, renal ultrasound (initial, and last follow up), voiding cystourethrogram (initial, and last follow up), and urodynamic studies at last follow up. Results: Thirty patients underwent PUVs ablation at a median age of 9 months. Ten (33.3%) patients were diagnosed antenatally. At the last follow up visit, 14 (46.7%) patients had moderate-severe CKD. Twenty-five (83.3%) patients had abnormalities in their urodynamic studies. Univariate analysis showed the need for re-ablation, use of anti-cholinergics, high initial serum creatinine, high nadir creatinine, presence of VUR, history of febrile UTIs and presence of proteinuria were significantly associated with low eGFR. Multivariate analysis showed that high nadir creatinine and presence of VUR were independent factors associated with lower e-GFR at last follow-up. Antenatal diagnosis was significantly associated with better e-GFR. Conculsion: Nadir creatinine and vesicoureteral reflux have high prognostic value for late renal functions, and antenatal diagnosis is associated with better renal functions in patients with posterior urethral valves. Increasing family awareness, antenatal care facilities,and referal to tertiary care centers are priorities for promoting the antenatal diagnosis and management in developing countries.Facilities and training for prenatal intervention should be encouraged.
Keywords:
- posterior urethral valves
- Urodynamic Studies
- Bladder Funtion
- Nadir Creatinine
How to Cite
Abdel-Salam, N. ., Mahfouz, W. ., Youssef, M. E.-S. ., Mohi-Eldin El- Kersh, M. ., & Abdel-Moneim, M. A. . (2020). Predictors of the Late Renal Outcome after Posterior Urethral Valves Ablation in a Developing Country: Long Term Study. Iranian Journal of Pediatric Surgery, 6(1), 19–29. https://doi.org/10.22037/irjps.v6i1.31699
References
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8. Ray A, Haldar P, Nanda D, et al: Posterior urethral valve-an evaluation and outcome in a tertiary care institution. J Evol Med Dent Sci 2017; 6: 14-8.
9. Petersen K, Moore D, Kala U: Posterior urethral valves in South African boys: Outcomes and challenges. S Afr Med J 2018; 108: 667-70.
10. Orumuah AJ, Oduagbon OE: Presentation, management, and outcome of posterior urethral valves in a Nigerian tertiary hospital. Afr J Paediatr Surg 2015; 12: 18-22.
11. Tambo FFM, Tolefac PN, Ngowe MN, et al: Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital. BMC Urol 2018; 18: 46-52.
12. Rianthavorn P, Parkpibul P: Long-term growth in children with posterior urethral valves. J Pediatr Urol 2019; 15: 264.e1-.e5.
13. Sarhan O, El-Ghoneimi A, Helmy TE, et al: Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol 2011; 185: 2491-6.
14. Heikkilä J, Taskinen S, Rintala R: Urinomas associated with posterior urethral valves. J Urol 2008; 180: 1476-8.
15. Coquillette M, Lee RS, Pagni SE, et al: Renal outcomes of neonates with early presentation of posterior urethral valves: a 10-year single center experience. J Perinatol 2020; 40: 112-7.
16. Lopez-Pereira P, Espinosa L, etal: Posterior urethral valves: prognostic factors. BJU Int 2003; 91: 687-90.
17. Vasconcelos M, Simões ESA, Dias C, et al: Posterior urethral valves: comparison of clinical outcomes between postnatal and antenatal cohorts. J Pediatr Urol 2019; 15: 167. e1-e8.
18. Kajbafzadeh A-M, Payabvash S, Karimian G: The effects of bladder neck incision on urodynamic abnormalities of children with posterior urethral valves. J Urol 2007; 178: 2142-9.
19. Otukesh H, Sharifiaghdas F, Hoseini R, et al: Long-term upper and lower urinary tract functions in children with posterior urethral valves. J Pediatr Urol 2010; 6: 143-7.
20. Nakamura S, Kawai S, Kubo T, et al: Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study. BJU Int 2011; 107: 1304-12.
21. Hennus PM, van der Heijden GJ, Bosch JR, et al: A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS One 2012; 7: e44663.
22. Keays MA, McAlpine K and Welk B: All grown up: A transitional care perspective on the patient with posterior urethral valves. Can Urol Assoc J 2018; 12: S10-S4.
23. Parkhouse H, Woodhouse C: Long-term status of patients with posterior urethral valves. Urol Clin North Am 1990; 17: 373-8.
24. Puri A, Grover VP, Agarwala S, et al: Initial surgical treatment as a determinant of bladder dysfunction in posterior urethral valves. Pediatr Surg Int 2002; 18: 438-43.
25. Ansari M, Surdas R, Barai S, et al: Renal function reserve in children with posterior urethral valve: a novel test to predict long-term outcome. J Urol 2011; 185: 2329-33.
26. Androulakakis PA, Karamanolakis DK, Tsahouridis G, et al: Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction? BJU Int 2005; 96: 140-3.
27. Uthup S, Binitha R, Geetha S, et al: A follow-up study of children with posterior urethral valve. Indian J Nephrol 2010; 20: 72-5.
28. Kumar L, Tiwari R, Sandhu A, et al: Follow up in posterior urethral valve after primary valve fulguration or diversion with fulguration with special references to urodynamic studies. Int J Med Sci Public Health 2017; 6: 113-8.
29. McLeod D, Szymanski K, Gong E, et al: Renal replacement therapy and intermittent catheterization risk in posterior urethral valves. Pediatrics 2019; 143: pii: e20182656.
30. Ansari M, Nunia SK, Bansal A, et al: Bladder contractility index in posterior urethral valve: A new marker for early prediction of progression to renal failure. J Pediatr Urol 2018; 14: 162. e1-. e5.
31. Ezel ÇM, Ekinci Z, Bozkaya YB, et al: Outcome of posterior urethral valve in 64 children: a single center's 22-year experience. Minerva Urol Nefrol 2019; 71: 651-6.
32. Parkhouse HF, Barratt T, Dillon M, et al: Long‐term outcome of boys with posterior urethral valves. Br J Urol 1988; 62: 59-62.
33. Ghanem MA, Wolffenbuttel KP, De Vylder A et al: Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol 2004; 171: 2409-12.
34. Lopez-Pereira P, Martinez Urrutia M, Espinosa L, et al: Bladder dysfunction as a prognostic factor in patients with posterior urethral valves. BJU Int 2002; 90: 308-11.
35. Sarhan O, Zaccaria I, Macher M-A, et al: Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol 2008; 179: 307-13.
2. Yosypiv IV: Hydronephrosis and obstructive uropathies, in Kher KK, Schnaper HW, Greenbaum LA (eds.): Clinical Pediatric Nephrology. 3rd ed. Boca Raton, Florida: CRC Press, 2017, 931-52.
3. Shukla A: Posterior urethral valves and urethral anomalies, in Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds.): Campbell-Walsh Urology 11th ed. Philadelphia: Elsevier, 2016, 3252-71.
4. Copelovitch L, Warady B, Furth S: Insights from the Chronic Kidney Disease in Children (CKiD) Study. Clin J Am Soc Nephrol 2011; 6: 2047-53.
5. Abrams P: Bladder outlet obstruction index, bladder contractility index, and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 1999; 84: 14-5.
6. Brownlee E, Wragg R, Robb A, et al: Current epidemiology and antenatal presentation of posterior urethral valves: Outcome of BAPS CASS National Audit. J Pediatr Surg 2019; 54: 318-21.
7. Bilgutay AN, Roth DR, Gonzales Jr ET, et al: Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol 2016; 12: 179. e1-. e7.
8. Ray A, Haldar P, Nanda D, et al: Posterior urethral valve-an evaluation and outcome in a tertiary care institution. J Evol Med Dent Sci 2017; 6: 14-8.
9. Petersen K, Moore D, Kala U: Posterior urethral valves in South African boys: Outcomes and challenges. S Afr Med J 2018; 108: 667-70.
10. Orumuah AJ, Oduagbon OE: Presentation, management, and outcome of posterior urethral valves in a Nigerian tertiary hospital. Afr J Paediatr Surg 2015; 12: 18-22.
11. Tambo FFM, Tolefac PN, Ngowe MN, et al: Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital. BMC Urol 2018; 18: 46-52.
12. Rianthavorn P, Parkpibul P: Long-term growth in children with posterior urethral valves. J Pediatr Urol 2019; 15: 264.e1-.e5.
13. Sarhan O, El-Ghoneimi A, Helmy TE, et al: Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol 2011; 185: 2491-6.
14. Heikkilä J, Taskinen S, Rintala R: Urinomas associated with posterior urethral valves. J Urol 2008; 180: 1476-8.
15. Coquillette M, Lee RS, Pagni SE, et al: Renal outcomes of neonates with early presentation of posterior urethral valves: a 10-year single center experience. J Perinatol 2020; 40: 112-7.
16. Lopez-Pereira P, Espinosa L, etal: Posterior urethral valves: prognostic factors. BJU Int 2003; 91: 687-90.
17. Vasconcelos M, Simões ESA, Dias C, et al: Posterior urethral valves: comparison of clinical outcomes between postnatal and antenatal cohorts. J Pediatr Urol 2019; 15: 167. e1-e8.
18. Kajbafzadeh A-M, Payabvash S, Karimian G: The effects of bladder neck incision on urodynamic abnormalities of children with posterior urethral valves. J Urol 2007; 178: 2142-9.
19. Otukesh H, Sharifiaghdas F, Hoseini R, et al: Long-term upper and lower urinary tract functions in children with posterior urethral valves. J Pediatr Urol 2010; 6: 143-7.
20. Nakamura S, Kawai S, Kubo T, et al: Transurethral incision of congenital obstructive lesions in the posterior urethra in boys and its effect on urinary incontinence and urodynamic study. BJU Int 2011; 107: 1304-12.
21. Hennus PM, van der Heijden GJ, Bosch JR, et al: A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS One 2012; 7: e44663.
22. Keays MA, McAlpine K and Welk B: All grown up: A transitional care perspective on the patient with posterior urethral valves. Can Urol Assoc J 2018; 12: S10-S4.
23. Parkhouse H, Woodhouse C: Long-term status of patients with posterior urethral valves. Urol Clin North Am 1990; 17: 373-8.
24. Puri A, Grover VP, Agarwala S, et al: Initial surgical treatment as a determinant of bladder dysfunction in posterior urethral valves. Pediatr Surg Int 2002; 18: 438-43.
25. Ansari M, Surdas R, Barai S, et al: Renal function reserve in children with posterior urethral valve: a novel test to predict long-term outcome. J Urol 2011; 185: 2329-33.
26. Androulakakis PA, Karamanolakis DK, Tsahouridis G, et al: Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction? BJU Int 2005; 96: 140-3.
27. Uthup S, Binitha R, Geetha S, et al: A follow-up study of children with posterior urethral valve. Indian J Nephrol 2010; 20: 72-5.
28. Kumar L, Tiwari R, Sandhu A, et al: Follow up in posterior urethral valve after primary valve fulguration or diversion with fulguration with special references to urodynamic studies. Int J Med Sci Public Health 2017; 6: 113-8.
29. McLeod D, Szymanski K, Gong E, et al: Renal replacement therapy and intermittent catheterization risk in posterior urethral valves. Pediatrics 2019; 143: pii: e20182656.
30. Ansari M, Nunia SK, Bansal A, et al: Bladder contractility index in posterior urethral valve: A new marker for early prediction of progression to renal failure. J Pediatr Urol 2018; 14: 162. e1-. e5.
31. Ezel ÇM, Ekinci Z, Bozkaya YB, et al: Outcome of posterior urethral valve in 64 children: a single center's 22-year experience. Minerva Urol Nefrol 2019; 71: 651-6.
32. Parkhouse HF, Barratt T, Dillon M, et al: Long‐term outcome of boys with posterior urethral valves. Br J Urol 1988; 62: 59-62.
33. Ghanem MA, Wolffenbuttel KP, De Vylder A et al: Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol 2004; 171: 2409-12.
34. Lopez-Pereira P, Martinez Urrutia M, Espinosa L, et al: Bladder dysfunction as a prognostic factor in patients with posterior urethral valves. BJU Int 2002; 90: 308-11.
35. Sarhan O, Zaccaria I, Macher M-A, et al: Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol 2008; 179: 307-13.
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