Delayed Presentation in Posterior Urethral Valve: Long-Term Implications and Outcome

Abstract

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