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Ekarat P, Attawettayanon W, Limratchapong C, Sophark P, Vachvanichsanong P. Posterior urethral valve in thai boys. BMC Pediatr 2023; 23:445. [PMID: 37679663 PMCID: PMC10483796 DOI: 10.1186/s12887-023-04281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Posterior urethral valve (PUV) is the most common congenital bladder outlet obstruction in boys, causing renal damage beginning in utero. There are scarce data from Thailand regarding the long-term outcomes of PUV in boys, thus the aim of this study was to examine the presentation, clinical course, complications, outcomes and renal survival in PUV boys. METHODS We reviewed the medical records of PUV boys treated at the Pediatric Nephrology Clinic, Prince of Songkla University, Thailand, over a 30-year-period. RESULTS Seventy-seven PUV boys were identified, with a median age at diagnosis of 4.8 months. The most common presentations were urinary tract infection (UTI), poor urine stream and urinary dribbling in 26 (33.8%), 19 (24.7%) and 11 (14.3%) boys, respectively. Renal ultrasound results in 70 boys showed 8 (11.4%) unilateral and 56 (80%) bilateral hydronephroses. Of 72 voiding cystourethrograms, 18 (25.0%) showed unilateral and 22 (30.6%) bilateral vesicoureteral refluxes. 99mTc dimercaptosuccinic acid renal scans in 30 boys showed 12 (40%) unilateral and 8 (26.7%) bilateral renal damage. Fifty-nine (76.6%) boys had 149 UTIs; 42 (54.4%) had recurrent UTI. Forty-eight boys had valve ablation at the median age of 30.3 months. 22 boys (28.6%) developed chronic kidney disease (CKD) at a median age of 15.0 years. CONCLUSION Of 77 PUV Thai boys, UTI was the most common presentation. Recurrence of UTI and CKD was the most common consequence. Lifelong follow-up for renal and bladder functions is essential for all PUV patients.
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Affiliation(s)
- Prakorn Ekarat
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Worapat Attawettayanon
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Chompoonut Limratchapong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Praewa Sophark
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Prayong Vachvanichsanong
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Oyinloye AO, Abubakar AM, Wabada S, Rikin CU. Experience with the use of mohan's valvotome for posterior urethral valve ablation at a centre in North-Eastern Nigeria. Afr J Paediatr Surg 2022; 19:144-148. [PMID: 35775514 PMCID: PMC9290366 DOI: 10.4103/ajps.ajps_188_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Posterior urethral valve (PUV) is the most common congenital cause of lower urinary tract obstruction in boys. Management has remained challenging in our region, with features of renal impairment evident in some patients at the time of presentation. Endoscopic valve ablation is the gold standard of treatment, but this is not readily available in our setting. Mohan's valvotome has been described as an alternative device for valve ablation. This study aimed to highlight the clinical presentation, management and early outcomes following valve ablation using Mohan's valvotome. METHODS A retrospective study of boys with PUVs managed between September 2014 and June 2018 was done. The demographic characteristics, clinical features, investigations, treatment and initial outcomes were reviewed. The main outcome measures were improved post-ablation urinary stream, serial serum creatinine values at presentation, 4-5 days of initial catheter drainage and at follow-up. RESULTS There were ten boys with the median age at presentation of 4 months (mean: 23.9 months; range 10 days to 7 years). Four patients presented after 1 year. All the patients had features of bladder outlet obstruction with associated fever in seven patients and urinary tract infections in six patients. Nine patients (90%) had suprapubic masses, while 2 had ballotable kidneys with co-existing urinary ascites in one patient. Valve ablation was achieved with Mohan's valvotome. There was a significant improvement in the urine stream in all patients. The median duration of follow-up was 7.5 months. Median serum creatinine was 0.95 mg/dl (mean 0.94 mg/d ± 0.38 mg/dl) at follow-up, compared to a median of 4.03 mg/dl at presentation (P = 0.01). CONCLUSION Initial drainage and definitive valve ablation with Mohan's valvotome is associated with improved serum creatinine and urinary stream.
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Affiliation(s)
- Adewale Olaotan Oyinloye
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
| | - Auwal Mohammed Abubakar
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
| | - Samuel Wabada
- Department of Surgery, Pediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Borno, Nigeria
| | - Christopher Uruku Rikin
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
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Prathap S, Narayanan SK. Does Early Upper Tract Diversion and Delayed Undiversion in Megaureters Secondary to Severe Posterior Urethral Valves Lead to Better Renal Outcomes? J Indian Assoc Pediatr Surg 2022; 27:196-203. [PMID: 35937119 PMCID: PMC9350658 DOI: 10.4103/jiaps.jiaps_366_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background There are conflicting reports for the management of severe posterior urethral valve (PUV) after ablation. The primary objective was to assess the renal outcomes using the estimated glomerular filtration rate (eGFR) and secondary outcomes in severe PUVs who underwent early partially diverting reduction ureterostomy (PDRU) and a delayed undiversion protocol. Materials and Methods This 10-year retrospective study reviewed the records of 1094 boys with PUV, where severe PUV cases were treated with early PDRU (324 surgeries). We then analyzed those patients who completed the early diversion and delayed undiversion protocol. The long-term renal outcomes using eGFR and antero-posterior diameter (APD) were compared at various time points using appropriate statistical methods. Results Of the 171 severe PUV patients who underwent PDRU, 31 completed undiversion and 26 (47 renal units) were analyzed after exclusions. The mean age (standard deviation) at presentation was 1.46 ± 4.1 months. Thirty-two units were refluxing and 15 were nonrefluxing megaureters. PDRU was closed at a mean age of 3.9 years and had a mean duration of follow-up of 6.4 years. The mean eGFR increased from a minimum of 10.78 ± 10.25 at baseline and remained stable at 28.69 ± 18.89 after closure of both stoma. Similarly, mean APD decreased from 12.07 ± 6.79 at the diagnosis to 7.00 ± 6.20. Three patients (3 renal units) required revision of the stoma for stenosis and 1 patient had a parastomal hernia that was repaired at the time of undiversion. Conclusions In severe PUVs, early PDRU with delayed undiversion is a reliable surgical option that may ensure better renal outcomes in the long-term. Nonrefluxing renal units recover better than the refluxing. APD measurements also are shown to improve favorably.
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Affiliation(s)
- Somnath Prathap
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India
| | - Sarath Kumar Narayanan
- Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode, Kerala, India,Address for correspondence: Dr. Sarath Kumar Narayanan, Department of Pediatric Surgery, IMCH, Government Medical College, Kozhikode - 673 008, Kerala, India. E-mail:
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Esezobor CI, Alakaloko AE, Admani B, Ellidir R, Nourse P, McCulloch MI. Paediatric Nephrology in Africa. CURRENT PEDIATRICS REPORTS 2021; 9:134-141. [PMID: 34721949 PMCID: PMC8542494 DOI: 10.1007/s40124-021-00256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We highlight the unique facets of paediatric nephrology in Africa in terms of the spectrum of kidney diseases, available diagnostic and treatment modalities, kidney healthcare financing options, paediatric nephrology manpower and the contribution of geography and demographics. RECENT FINDINGS Paediatric acute kidney injury in Africa is now commonly due to sepsis rather than gastroenteritis. Steroid-sensitive form of nephrotic syndrome is far more common than was two decades ago. SUMMARY The hot arid climate in North Africa and the tropical climate in most of sub-Saharan Africa, and the high rate of consanguinity, sickle cell disease and HIV drive the spectrum of paediatric kidney diseases in the continent. Kidney diseases are often precipitated by infectious triggers associated with poor living conditions and little access to medical care thus resulting in late presentation and often end-stage kidney disease. Although accessibility to kidney care has improved in the continent due to training opportunities provided by international professional organisations, most children still face significant barriers to kidney care because they live in rural areas, governments spend the least on healthcare and the continent has the least density of healthcare practitioners and nephrology trainees.
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Affiliation(s)
- Christopher I. Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos State Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos State Nigeria
| | - Adebimpe E. Alakaloko
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos State Nigeria
| | - Bashir Admani
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Rashid Ellidir
- Department of Pediatric Nephrology, Noura Children Center for Kidney Disease and Transplantation, Soba University Hospital, Khartoum, Sudan
- Multi Organ Transplant Centre (MOTC), Paediatric Nephrology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Peter Nourse
- Depatment of Pediatric Nephrology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Mignon I. McCulloch
- Depatment of Pediatric Nephrology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
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Shields LBE, White JT, Mohamed AZ, Peppas DS, Rosenberg E. Delayed Presentation of Urethral Valves: A Diagnosis That Should Be Suspected Despite a Normal Prenatal Ultrasound. Glob Pediatr Health 2020; 7:2333794X20958918. [PMID: 33117862 PMCID: PMC7570289 DOI: 10.1177/2333794x20958918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background. Congenital urethral obstruction occurs most frequently as a result of urethral valves. The diagnosis is usually confirmed pre- or neonatally. Though not ideal, delayed diagnosis can occur in childhood, adolescence, or adulthood. Despite a normal prenatal ultrasound, there may still be a delayed diagnosis of urethral valves. Methods. We present 4 patients with delayed diagnosis of posterior urethral valves (PUV) and 1 patient with delayed diagnosis of anterior urethral valves (AUV) who were evaluated by a pediatric urologist at our Institution. We determined the age and symptoms at presentation, physical examination, micturating cystourethrogram (MCU) findings prior to the valve ablation, renal function before and after valve ablation, type of valve ablation, and urine culture and sensitivity. The urological courses following urethral valve ablation including urodynamic study findings are described. Results. The median age at presentation was 33 months. All 5 patients presented with decreased urine output and urinary retention. All 5 patients underwent a MCU that demonstrated bladder trabeculations (3 cases), vesicoureteral reflux (3 cases), and bladder diverticula (2 cases). A urethral valve ablation was performed in all cases. Four patients underwent a renal function panel prior to this procedure, and their serum BUN/creatinine levels decreased 1 day postoperatively. Conclusion. Pediatricians should consider urethral valves as causing urethral obstruction although the prenatal ultrasound may be normal. Early diagnosis and prompt treatment of urethral valves may mitigate the potentially devastating morbidities such as renal failure, congestive heart failure, and respiratory distress that may ensue.
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Affiliation(s)
| | | | - Ahmad Z Mohamed
- University of Louisville School of Medicine, Louisville, KY, USA
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Neyas A, Bajaba R, AlThomali R, Alturkistani R, AlSawaf B, Alrefai W, Hefni L, Aldoobie L, Desoky S, Kari J, Safdar OY. Correlation between the estimated GFR and SWRD score in patients with posterior urethral valves at King Abdul-Aziz University Hospital. BMC Res Notes 2019; 12:81. [PMID: 30755266 PMCID: PMC6373006 DOI: 10.1186/s13104-019-4120-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The aim was to establish the reliability of the SWRD score as a predictor of both renal and bladder outcomes in posterior urethral valves. This retrospective study included 67 patients with PUVs at King Abdul-Aziz University Hospital. The score was calculated from voiding cystourethrogram before and after the relief of obstruction, and estimated glomerular filtration rates (eGFRs) were calculated as well. Results Based on Spearman correlations, both baseline eGFRs and SWRD scores can be possible predictors of long-term renal outcomes, as a significant positive correlation between the baseline eGFRs and the last eGFRs was found (p = 0.005). A significant negative correlation was also found between the SWRD score calculated before the intervention and the last eGFRs (p = 0.02). Additionally, the baseline SWRD scores can be possible predictors of short-term bladder outcomes, as the correlation analysis showed a positive relationship between the baseline SWRD scores and the SWRD scores calculated within 2 months after the intervention (p < 0.0001). A significant decrease in SWRD scores and eGFRs was found from before to after the intervention, regardless of the type of intervention. In conclusion, the SWRD scoring system proved to be a potentially promising tool in the anticipation of the clinical outcomes of PUVs.
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Affiliation(s)
- Afnan Neyas
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Rana Bajaba
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf AlThomali
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf Alturkistani
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Baraah AlSawaf
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Weaam Alrefai
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lujain Hefni
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lamees Aldoobie
- Faculty of Medicine & Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif Desoky
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jameela Kari
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y Safdar
- Pediatirc Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Saudi Arabia
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Indiran V, Kannan K, Prasad TR, Maduraimuthu P. Spinnaker sail sign. Abdom Radiol (NY) 2018; 43:1845-1846. [PMID: 29094175 DOI: 10.1007/s00261-017-1371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India.
| | - Kanakaraj Kannan
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India
| | - T Ramachandra Prasad
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India
| | - Prabakaran Maduraimuthu
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai, Tamilnadu, 600044, India
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Tambo FFM, Tolefac PN, Ngowe MN, Minkande JZ, Mbouche L, Guemkam G, Telelen NA, Angwafo FF, Sosso AM. Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital. BMC Urol 2018; 18:46. [PMID: 29783971 PMCID: PMC5963049 DOI: 10.1186/s12894-018-0364-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 05/11/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The incidence of posterior urethral valve (PUV) is estimated at 1:5000-1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV. METHODS Retrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality. RESULTS A total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%. CONCLUSION Many patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction.
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Affiliation(s)
- Faustin Felicien Mouafo Tambo
- Departmennt of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Paediatric Surgery Unit, Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon
| | - Paul Nkemtendong Tolefac
- Specialized Internship Program, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Marcelin Ngowe Ngowe
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Jacqueline Ze Minkande
- Department of Anaesthesia and Intensive Care, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Anaesthesia and Intensive Care, Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon
| | - Landry Mbouche
- Paediatric Surgery Unit, Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon
| | - Georgette Guemkam
- Paediatric Nephrology Unit, Mother and Child Centre, Chantal Biya Foundation, Yaoundé, Cameroon
| | | | - Fru Fobuzshi Angwafo
- Departmennt of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Paediatric Surgery Unit, Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Yaoundé, Cameroon
| | - Aurelien Maurice Sosso
- Departmennt of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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