Abstract
BackgroundPosterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care.MethodsThis was a single-center ambispective cohort study carried out over a period of 2 years. Patient data regarding the symptoms, investigations, interventions, secondary complications were recorded and were followed up regularly during the study till either normalization of their creatinine level which was maintained up to one-year post-fulguration (non-CKD) or progression to end-stage renal disease (ESRD) requiring renal transplant. Various clinical factors were then compared between these groups.ResultsThe age of presentation varies from 6 months antenatal period to a maximum of 34 years. Most common symptom was of lower urinary tract obstruction, followed by recurrent febrile UTI. The interval between disease presentation detection and PU valve fulguration ranged from 6 days to more than 5 years, median duration being 1 month. 85.7% patients had hydroureteronephrosis on initial USG. In VCUG, there was no significant difference found between the presence of reflux and poor renal outcome. Age of presentation greater than 2 years was seen in 52% of patients with CKD compared to only 10% patients in non-CKD group (significant, p value 0.02). Among patients who developed CKD, 60% of patients had PU valve fulguration after one month of disease presentation, while in contrast, among the non-CKD group, 80% of patients had it done within one month of disease presentation. (significant, p value 0.03).ConclusionsLate age of presentation, delayed fulguration with high initial creatinine, and failure of serum creatinine to return to normal after one-month post-fulguration are important risk factors in the progression of the disease to ESRD. Symptomatic improvement after interventions does not correlate with progression to ESRD. The number of interventions also does not predict progression to ESRD. Interventions should be chosen wisely on case to restore near-normal physiology and delay progression to ESRD.
Highlights
Posterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care
Surgical intervention is the mainstay of management in Posterior urethral (PU) valve, and these patients require a variable number of interventions from time to time according to their disease status
We found out a significant difference in chronic kidney disease (CKD) progression and interval between disease presentation and valve fulguration of more than one month (p value < 0.05)
Summary
Posterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care. Posterior urethral valves (PUV) result from a congenital malformation of the male urethra at the junction of the membranous and penile urethra that causes obstruction. Velhal et al African Journal of Urology (2021) 27:158 stream or urinary incontinence, growth retardation, or with associated kidney failure. Long-term renal outcome remains poor, with as many as 30% of patients progressing to renal failure [3]. The current surgical treatment of PUV is primary valve ablation via trans-urethral cystoscopy. Diagnosed patients can be treated with fetal surgeries such as vesico-amniotic shunting or cystoscopy and valve ablation
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