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Yadav P, Rickard M, Kim JK, Richter J, Lolas M, Alshammari D, Chua ME, Dos Santos J, Lorenzo AJ. Comparison of outcomes of prenatal versus postnatal presentation of posterior urethral valves: a systematic review and meta-analysis. World J Urol 2022; 40:2181-2194. [PMID: 35943527 DOI: 10.1007/s00345-022-04097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes. METHODS We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible. RESULTS The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias. CONCLUSION The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Dheidan Alshammari
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon, Philippines
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Farrugia MK. Fetal bladder outlet obstruction: Embryopathology, in utero intervention and outcome. J Pediatr Urol 2016; 12:296-303. [PMID: 27570093 DOI: 10.1016/j.jpurol.2016.05.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022]
Abstract
Fetal bladder outlet obstruction (BOO), most commonly caused by posterior urethral valves (PUV), remains a challenging and multi-faceted condition. Evolving techniques, and refinement in ultrasound, optics and instrumentation, have increased our rate of prenatal diagnosis, and enabled valve ablation not only in smaller newborns, but also in fetuses. Long-term outcome studies have raised our awareness of the silent damage caused by bladder dysfunction and polyuria and encouraged their proactive management. In spite of our best efforts, the proportion of boys with PUV who progress to chronic and end-stage renal disease (ESRD) has not changed in the last 25 years. Evidence suggests a reduction in perinatal mortality following prenatal intervention, probably resulting from amelioration of oligohydramnios at the crucial time of lung development between 16 and 28 weeks' gestation, but no improvement in postnatal renal outcome. There are no bladder functional outcome studies in patients who have undergone prenatal intervention and hence the long-term effect of in utero defunctionalisation of the bladder is not known. This aim of this review is to revisit the embryopathology of fetal BOO, in particular the renal and bladder structural and functional changes that occur with in utero obstruction. The effect of earlier prenatal diagnosis, and therapy, on postnatal outcome is also explored and compared with outcomes published for traditional postnatal treatment.
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Affiliation(s)
- Marie-Klaire Farrugia
- Chelsea Children's Hospital at the Chelsea & Westminster Hospital Foundation Trust, London SW10 9NH, UK.
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Bilgutay AN, Roth DR, Gonzales ET, Janzen N, Zhang W, Koh CJ, Gargollo P, Seth A. Posterior urethral valves: Risk factors for progression to renal failure. J Pediatr Urol 2016; 12:179.e1-7. [PMID: 26705688 PMCID: PMC4882264 DOI: 10.1016/j.jpurol.2015.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/22/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUVs) are the most common etiology for congenital urethral obstruction and congenital bilateral renal obstruction. PUVs produce a spectrum of urologic and renal sequelae. Our aims were to assess outcomes of PUV patients, to determine whether vesicoureteral reflux (VUR) is a risk factor for progression to renal failure, and to identify other risk factors for poor outcomes. MATERIALS AND METHODS We conducted a retrospective analysis of PUV patients from 2006 to 2014. Data collected included demographics, initial renal ultrasound (RUS) findings, creatinine at presentation and nadir, pre- and postoperative VUR status, presence or absence of recurrent urinary tract infections (UTIs), and surgical intervention(s). Univariate and multivariate analyses were used to determine risk factors for renal failure. RESULTS Of 104 patients, 42.3% (44/104) were diagnosed prenatally, 31.8% (14/44) of whom underwent prenatal intervention. Postnatally, 90.4% (94/104) initially underwent transurethral resection of PUVs (TUR-PUVs). Vesicostomy was the next most common index surgery (4.8%). Forty-two percent (44/104) required >1 surgery. The predominant second surgery was repeat TUR-PUV in 16 patients. At last follow-up (mean 28.8 months after initial surgery), 20.2% had chronic kidney disease (CKD) of at least stage IIIA, and 8.6% had progressed to end-stage renal disease (ESRD). Antenatal diagnosis, prematurity, abnormal renal cortex, and loss of corticomedullary differentiation (CMD) on initial RUS were associated with CKD and ESRD on univariate analysis, as were elevated creatinine on presentation and at nadir. Presence of pre- or postoperative VUR and recurrent UTIs were associated with the need for multiple surgeries, but not with poor renal outcomes. On multivariate analysis, nadir creatinine was the only independent predictor of final renal function. CONCLUSIONS Our finding that creatinine is the only independent risk factor for poor renal outcomes in PUV patients is consistent with the literature. The effect of VUR has been controversial, and our finding that VUR is associated with need for multiple surgeries but not with CKD or ESRD is novel. Limitations include biases inherent to retrospective studies and relatively small sample size. The majority of patients with PUVs (56.7%) required one surgery and maintained renal function with CKD II or better (79.8%) up to 2 years after initial surgery. While multiple factors were associated with poor renal outcomes, nadir creatinine was the only independent predictor. VUR and recurrent UTIs were not associated with poor renal outcomes. Longer follow-up is necessary to identify risk factors for delayed progression of renal disease.
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Affiliation(s)
- Aylin N Bilgutay
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - David R Roth
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Edmond T Gonzales
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Nicolette Janzen
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Wei Zhang
- Texas Children's Hospital, Houston, TX, USA
| | - Chester J Koh
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Patricio Gargollo
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Abhishek Seth
- Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Riah L, Belhaj K, Lmidmani F, El Fatimi A, El Kettani Y, El Ayoubi M, Rabii R, Meziane F, El Atiqi F, Sbai H. [Urodynamic profile of voiding disorders persisting after treatment of posterior urethral valve]. Prog Urol 2014; 25:217-23. [PMID: 25450753 DOI: 10.1016/j.purol.2014.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/23/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. MATERIAL AND METHODS We realize a retrospective study and examined 35 boys with urinary disorders post-treatment of PUV, seen at the urodynamic consultation. RESULTS The mean age: 7.56 years, urinary problems are dominated by recurrent urinary tract infections and urinary leakage, morphological assessment is marked by the constant expansion of the urinary tract and bladder, 18 children have end-stage renal disease of which 8 are candidates for transplantation. About urodynamic, the uroflowmetry with measure of post-void urine residue: dysuria with significant residual urine in 14 children; for cystometry, 20 children with bladder hyperactivity, 9 bladders are hypotonic hypoactive with high capacity, 6 explorations are normal. CONCLUSION Urodynamic explorations are all interest when voiding symptoms persist after endoscopic section valves and despite a good radiological result.
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Affiliation(s)
- L Riah
- Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc.
| | - K Belhaj
- Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc
| | - F Lmidmani
- Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc
| | - A El Fatimi
- Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc
| | - Y El Kettani
- Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc
| | - M El Ayoubi
- Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc
| | - R Rabii
- Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc
| | - F Meziane
- Service d'urologie, CHU Ibn Rochd, Casablanca, Maroc
| | - F El Atiqi
- Service de chirurgie pédiatrique, hôpital d'enfants, Casablanca, Maroc
| | - H Sbai
- Service de chirurgie pédiatrique, hôpital d'enfants, Casablanca, Maroc
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