Long Term Outcome of Prenatally Detected Posterior Urethral Valves: Impact of Prenatal Parameters and Primary Valve Ablation in 65 Cases

Abstract

Purpose Our previous study (J Urol 1999) on the outcome of prenatally detected PUV was limited by the number of patients and the short follow up. We wished to revisit our series with a longer follow up and a larger cohort of patients managed in a standardised manner after the prenatal diagnosis Material and methods Between 1987 and 2004, 79 cases of PUV were detected prenatally and managed at our hospital; pregnancy was terminated in 14 and 65 were treated postnatally. Postnatal treatment was early valve ablation without routine preoperative drainage. We studied prenatal parameters: age of gestation at diagnosis, renal parenchyma on ultrasound, and amniotic fluid volume. Fetal urine and blood were analyzed when indicated. Clinical, biochemical and radiological outcome were reviewed Results Median follow up was 6.8 years (1- 14.3). Eleven (17%) of the 65 neonatal survivors developed renal failure and 6 had end stage renal disease. Gestational age at diagnosis and oligohydramnios were statistically significant predictors of final renal outcome (p = 0.003 and 0.02, respectively) while renal parenchymal changes on prenatal ultrasound were not significant (p = 0.23). When fetal urine and blood analysis detected good prognosis, one developed renal failure (7%), while renal failure developed in one of the 2 cases with a bad prognosis. Continence was achieved in 42/55(76%) toilet trained children, three had severe bladder dysfunction and needed clean intermittent catheterization Conclusions Gestational age at diagnosis and volume of amniotic fluid are significant predictors of final renal outcome. Biochemical and ultrasonographic parameters still need further improvement of their predictive values. Compared to other published series, our long term results show that early valves ablation can be considered as the primary and only treatment in the majority of cases without the need of preoperative drainage or diversion. Bladder dysfunction remains a challenging factor in the management of these children