Ten years institutional experience with study of prognostic factors affecting renal outcome in children with posterior urethral valves
Keywords:Posterior urethral valves, Prognostic factors, Chronic renal failure, Nadir serum creatinine, Bladder dysfunction
Background: Evaluation of our 10 year’s experience and analyze the prognostic factors affecting renal outcome in children with posterior urethral valves (PUV).
Methods: We retrospectively reviewed the medical records of 129 patients diagnosed and managed as posterior urethral valves from 2009 till 2019 in our institution age of presentation, signs and symptoms, anthropometry, surgical interventions, and biochemical investigations were recorded and data were analyzed on an excel spreadsheet.
Results: Mean age of presentation was 3 years and mean follow up was 4 years. 99 underwent primary valve ablation and 30 patients underwent diversion as primary treatment, the most common presenting symptom was poor urinary stream (90), enuresis (88), and fever (60). Correlation of resolution of symptoms pre and postoperatively was statistically not significant. 26% patients developed chronic renal failure (CRF) and 8.5% patients progressed to end stage renal disease (ESRD). Correlation of mean nadir serum creatinine >1 mg/dl (p=0.030), presence of protenuria (p=0.020), bladder dysfunction (p=0.029), bilateral high grade vesicoureteric reflux (VUR) (p=0.019), hypertension (p=0.01) was statistically significant. Correlation of age of presentation (p=0.341), outcome for patients treated with diversion or valve ablation in relation to CRF (p=0.239), incontinence (p=0.209), malnutrition (p=0.194) was statistically insignificant.
Conclusions: Nadir serum creatinine >1 mg/dl, presence of protenuria, bladder dysfunction, bilateral high grade VUR are significant prognostic factors affecting long term outcome in PUV. Early detection and timely management may lead to a better outcome in these patients.
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