Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves

Simultaneous primary posterior urethral valves ablation and bladder neck incision may decrease kidney and bladder failure in long-term follow-up in patients with bladder neck hypertrophy and poor bladder function at presentation: report of 301 cases

OBJECTIVES

To investigate the effects of bladder neck incision (BNI) and primary valves ablation on long-term kidney and bladder function in children with posterior urethral valves (PUV) and bladder neck hypertrophy (BNH).

PATIENTS AND METHODS

From 1997 to 2016, a total of 1381 children with PUV were referred to our tertiary hospital. Of these patients, 301 PUV patients with bladder neck hypertrophy need concurrent BNI and valve ablation. All patients were followed up every 3-6 months on regular basis in first 2 post-surgical years and annually then after. The paired t-test and chi-square test were used to perform statistical analysis with p value < 0.05 defined as the level of significance.

RESULTS

Mean age at diagnosis was 7.22 ± 2.45 months (ranging from 7 days to 15 months) with a mean follow-up of 5.12 ± 2.80 years. The incidence of hydronephrosis was decreased from 266 (88.3%) at the baseline to 73 (24.3%) patients in long-term follow-up. At baseline, 188 (62.5%) patients were diagnosed with VUR, which decreased to 20 (6.6%) individuals at the end of follow-up. Bladder and renal function were improved in follow-ups following concomitant PUV ablation and BNI. No Myogenic failure was depicted in all patients with BNH. No ureteric reimplantation was needed during the two decades follow-up.

CONCLUSION

Simultaneous valve ablation with BNI may present further profits in children with PUV and BNH particularly cases of BNH with poor bladder function at the time of presentation. This method can improve the results of urodynamic and imaging studies after the surgery. We hypothesize every child with PUV presentation who has concurrent vesicoureteral reflux, CKD or persistent hydrourethronephrosis may suffer from secondary bladder neck obstruction. This secondary bladder outlet obstruction must be managed through BNI as the surgical relief.

Mid-short-term risk factors for chronic renal failure in children with posterior urethral valve

OBJECTIVES

To analyze the mid-short-term risk factors for chronic renal failure (CRF) in children with posterior urethral valve (PUV) after valve ablation.

MATERIALS AND METHODS

A retrospective study of 143 patients with PUV who underwent operation was performed. Patients were divided into CRF group (n = 39) and non-CRF group (n = 104). Clinical data of both groups such as the first resection age, last resection age, number of operations, the maximal detrusor pressure (Pdet_max), and vesicoureteral reflux (VUR) were collected and analyzed.

RESULTS

The first resection age, last resection age, and the Pdet_max of patients in the CRF group were higher than those of patients in the non-CRF group (P < 0.05). Multiple regression analysis showed that the indicators related to chronic renal failure were last resection age (β = 1.034, P < 0.05) and Pdet_max (β = 1.068, P < 0.05). The cut-off value of last resection age was 35.5 months, Pdet_max was 41.65 cmH₂O. There was positive correlation of final blood creatinine with last resection age and Pdet_max.

CONCLUSION

The last resection age and Pdet_max are the risk factors of chronic renal failure in children with PUV. A Pdet_max of lower than 41.65 cmH₂O indicates a good prognosis of renal function in patients with PUV.

Experience with the use of mohan's valvotome for posterior urethral valve ablation at a centre in North-Eastern Nigeria

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.