1
|
Ebach F, Wagner P, Stein R, Dolscheid‐Pommerich R, Reutter H, Hilger AC. Familial congenital lower urinary tract obstruction (LUTO) suggested by screening for lower urinary tract dysfunction in parents of patients: A descriptive study. Health Sci Rep 2024; 7:e1935. [PMID: 38524771 PMCID: PMC10957716 DOI: 10.1002/hsr2.1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 03/26/2024] Open
Abstract
Background Congenital lower urinary tract obstruction (LUTO) describes a heterogeneous group of congenital malformations. Posterior urethral valves (PUV) represent the most common entity. Familial occurrence has been described, suggestive of underlying genetic factors. LUTO can occur in various degrees of severity. In severe forms, oligohydramnios, pulmonary hypoplasia, and renal damage can occur resulting in high pre- and postnatal mortality. On the contrary, mild forms may become apparent through recurrent urinary tract infections. Such high phenotypic variability has been described even within the same family. Here, we systematically screened parents of affected children for symptoms of LUTO. Methods The study population consisted of parents of LUTO patients. Fathers over 50 years of age were excluded, to avoid inclusion of male phenocopies due to early prostatic hypertrophy. Uroflowmetry, ultrasonography for residual urine and hydronephrosis, and laboratory examination of standard renal retention parameters were assessed, and a detailed patient history was taken, including the assessment of the International Prostate Symptom Score. Results Twenty-nine of 42 LUTO families enrolled were found eligible for the present study. Of these, we identified five families in which the father had already been diagnosed with infravesical obstruction (17%). Of the remaining families, nine agreed to participate in our study. Of these nine families, eight families had a child affected with PUV and one family had a child with urethral stenosis. Here, we found two fathers and one mother with symptoms of LUTO suggestive of mild LUTO and one family, in which the unborn male fetal brother of the affected index patient was also diagnosed prenatally with LUTO. Conclusion Our observations suggest that LUTOs have a higher heritability than previously thought and that first-degree relatives of the affected should be clinically assessed for symptoms of LUTO.
Collapse
Affiliation(s)
- Fabian Ebach
- Department of Neonatology and Pediatric Intensive CareUniversity Hospital BonnBonnGermany
| | - Pauline Wagner
- Department of Neonatology and Pediatric Intensive CareUniversity Hospital BonnBonnGermany
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
| | | | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive CareUniversity Hospital ErlangenErlangenGermany
| | - Alina C. Hilger
- Department of Pediatrics and Adolescent MedicineUniversity Hospital ErlangenErlangenGermany
- Research Center on Rare Kidney Diseases (RECORD)University Hospital ErlangenErlangenGermany
| |
Collapse
|
2
|
Forlini V, Pellegrino C, Lena F, Capitanucci ML, Van Uitert A, Mosiello G. Thulium Laser for the Treatment of Posterior Urethral Valves in Infants. J Endourol 2023; 37:1276-1281. [PMID: 37742112 DOI: 10.1089/end.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
Objective: Thulium laser (ThL) has become popular in urology, because of its powerful action on tissue, achieving optimal ablation and hemostasis. Aim of our article was to evaluate efficacy of ThL in infants affected by posterior urethral valve (PUV) ablation. Patients and Methods: Clinical charts of 25 infants (age ≤12 months) who underwent PUV ablation were retrospectively reviewed. According to our protocol, all patients performed voiding cystourethrography and cystoscopy 6 to 8 months after initial treatment. Several factors, including age and weight at surgery, operative time, postoperative bleeding, catheterization period, postoperative urinary retention, retreatment for valve remnants, and stricture at follow-up, were evaluated. Preoperative, intraoperative, and postoperative data were analyzed. Results: Mean age at primary surgery was 4.5 months (5 days-10.5 months) and mean weight at primary surgery was 5.7 kg (2.5-10.3 kg). Mean operative time was 29.5 minutes (range 15-50 minutes). None of the patients experienced intraoperative and postoperative bleeding. In all cases, postoperative catheterization period was 1 day. Residual valves were found in 6 of 25 (24%) patients. No cases of urethral stricture were registered during follow-up (48.4 months, range: 11-95). Analyzing literature data using other techniques, complication rate of ThL PUV ablation seems lower than standard treatments (electrofulguration, cold knife) and comparable with those reported with other laser techniques. Conclusion: PUV ablation with ThL has proven to be feasible and safe in infants. Further studies are needed to define the real effectiveness of this laser technology in PUV ablation. Miniaturized instruments and ThL technology make early PUV treatment feasible also in low body weight newborns.
Collapse
Affiliation(s)
- Valentina Forlini
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Pediatric Surgery Division, University of Genoa, Genoa, Italy
| | - Chiara Pellegrino
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
| | - Federica Lena
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Pediatric Surgery Division, University of Genoa, Genoa, Italy
| | - Maria Luisa Capitanucci
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
| | - Allon Van Uitert
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giovanni Mosiello
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
| |
Collapse
|
3
|
Paladugu S, Vasudeva A, Poojari VG, Machado NM, Roopa PS, Hegde N, Mundkur A, Kumar V. Associations, follow up data, and postnatal outcome of antenatally diagnosed Urinary Tract Dilatation - Five-year single tertiary center experience from South India. J Pediatr Urol 2023; 19:89.e1-89.e8. [PMID: 36404195 DOI: 10.1016/j.jpurol.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urinary tract dilatations (UTD) are frequently diagnosed during Mid-Trimester Anomaly Scan (MTAS), at which time, given their variable progression and heterogeneous classification systems, offering suitable counsel to the couple is challenging. OBJECTIVE Based on postnatal data, we aimed to guide parental counseling, and further evaluation of UTD diagnosed at MTAS. Specifically, the utility of multi-disciplinary UTD classification system was tested. METHODS A retrospective observational study of all UTDs included from five years (2015-2020) MTAS register. The multi-disciplinary UTD classification system was used for antenatal/postnatal UTD categorization. Follow-up data were obtained from case records until the current age of children (2-6 years). RESULTS Out of 527 fetal abnormalities, 103 had UTD at MTAS. Based on the third-trimester ultrasound, 49 were low-risk UTD A1, and 44 were increased-risk UTD A2-3 (including the nineteen UTD A1 at MTAS worsened to A2-3 by third-trimester). On postnatal follow-up of UTD A1 and A2-3, respectively, neonatal UTD P2/P3 was seen in 2% and 40.9%; complete spontaneous resolution was seen in 79.5% and 43.18%; none and 22.7% underwent surgical intervention; persistent P2/P3 UTD were seen on follow-up in 2% and 4.5% (excluding those who needed surgery); impaired renal function was seen in none and 36.3%, and recurrent UTI in 8.1% and 34.09%. The subgroup with progressive UTD (from A1 to A2-3 by third-trimester ultrasound) formed 43% of the final UTD A2-3 category. Among these 19 cases, surgical intervention was performed in eight (42%); impaired renal function was seen in 7 cases (36.8%), and recurrent UTI was seen in eight (42%). DISCUSSION Given the diverse classification systems for UTD, ours is the second Indian data proving the prognostic utility of multi-disciplinary UTD classification system, specifically at third trimester scan, based on postnatal outcome. In contrast to published guidelines, our data suggests follow-up for renal pelvis anteroposterior diameter (APD) of 4-7 mm at MTAS, as some may worsen. Similar progression has been noted in other Indian studies, but the classification systems are different. Contrary to the published literature, we could not suggest a renal APD cut-off as a single criterion to predict surgical intervention. Significant limitations are retrospective observational design and multiple sonographers. CONCLUSION Our data helps guide parental counseling and further evaluation for UTD diagnosed at MTAS. The multi-disciplinary Consensus UTD Classification system, was helpful in prognostication.
Collapse
Affiliation(s)
- Sanghamitra Paladugu
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Akhila Vasudeva
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Vidyashree Ganesh Poojari
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Nehal Meghna Machado
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - P S Roopa
- Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India; Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Nivedita Hegde
- Division of Foetal Medicine, Department of OBG, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Anjali Mundkur
- Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| | - Vijay Kumar
- Department of Paediatric Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
| |
Collapse
|
4
|
Wu CQ, Lovin JM, Patil D, Smith EA. Role of progressive urethral dilation and primary valve ablation in the long-term renal outcomes of small, preterm infants with posterior urethral valve. J Pediatr Urol 2022; 18:802.e1-802.e6. [PMID: 35780046 DOI: 10.1016/j.jpurol.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION PUV patients managed with primary vesicostomy instead of primary valve ablation (PVA) historically are preterm, low-birth-weight (LBW) infants with inadequate urethral size. We previously described progressive urethral dilation (PUD) as an effective method of enhancing the likelihood of PVA in these infants, allowing equal access to PVA as an initial management method. OBJECTIVE We aim to characterize renal outcomes in patients managed with PUD + PVA and compare this to outcomes with PVA alone. We also re-examine the effect of LBW and gestational age on renal outcomes in PUV with a cohort treated uniformly by PVA. METHODS We performed retrospective review of 78 neonates with PUV treated with PVA prior to 10 weeks of age with >1 year of follow up. Before valve ablation, boys either underwent PUD (serial upsizing of a smaller bore urethral catheter to an 8Fr catheter; PUD + PVA) or non-dilation (smaller bore catheter was maintained; PVA-only). PUD + PVA versus PVA-only was compared using chi-square and t-test. Logistic regression was performed to assess the effect of PUD, preterm (<37 weeks), LBW (<2.5 kg), and other predictors on the final outcomes of CKD3+ and ESRD. RESULTS 31 of 78 patients underwent PUD + PVA. Mean follow up was 5.2 years (SD 3.4), with no significant difference between PUD + PVA and PVA-only. The PUD + PVA group included significantly lower gestational age infants with lower birth weight and ablation weight. There was no significant effect of PUD on final CKD3+ or ESRD outcome on univariable or multivariable analysis. When adjusted for other variables, only Cr nadir >0.5 remained an independent predictor of CKD3+ (OR 41.2; p < 0.001) and ESRD (OR 18.9; p = 0.015). DISCUSSION We previously demonstrated that PUD is an effective means to achieve PVA in small neonates who might otherwise require vesicostomy. The data herein demonstrates no significant effect of PUD on renal outcomes. In this unique cohort of newborns treated with PVA, only creatinine nadir and not gestational age or an independent predictor of outcomes. CONCLUSION In small preterm infants who would have been excluded from PVA due to limited urethral size, PUD + PVA confers the same renal outcomes as PVA alone in larger infants. This novel data will assist in the risk-benefit analysis of using PUD before PVA in newborns diagnosed with PUV. When primary intervention is uniformly PVA, preterm birth and LBW are not independent predictors of renal outcomes.
Collapse
Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer M Lovin
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA; Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA; Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
5
|
Wu CQ, Blum ES, Patil D, Smith EA. Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves. J Pediatr Urol 2022; 18:813-9. [PMID: 35840456 DOI: 10.1016/j.jpurol.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood. Bladder and posterior urethral deformity in infants with PUV are highly variable on initial voiding cystourethrogram (VCUG). Some types of deformity may be more important than others in determining the severity of the condition. Identification of specific VCUG features may allow for a simple, early screening assessment for patients. OBJECTIVE Determine whether morphologic features on the initial VCUG correlate to renal outcomes as measured by the creatinine nadir in the first year after ablation. METHODS Children with PUV treated by primary valve ablation before 12 months old and followed >1 year were identified. Initial diagnostic VCUG was evaluated for the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), and posterior-anterior urethral ratio (PA-UR). A trabeculation grade was assigned by three pediatric urologists, and reflux was noted. Univariable analyses with chi-square and t-test were used to compare bladder and posterior urethral morphology factors among those who obtained a creatinine nadir <0.8 or ≥0.8 mg/dL in the first year after ablation. Linear regression was performed to correlate morphology values with true creatinine nadir. RESULTS A total of 120 boys were ablated at mean age of 40.5 days (range 0-342) and followed for 5.9 years (± 3.85). Among these, 21 (17.5%) had a creatinine nadir ≥0.8 mg/dL. Mean overall HW-B and mean PA-UR were not significantly different between those with creatinine nadir <0.8 versus ≥0.8 mg/dL. Bladder trabeculation grade was not associated with creatinine nadir. For the entire cohort, only the difference in HW-PU was statistically significant between creatinine nadir groups with a much higher ratio among those with a nadir ≥0.8 (p < 0.001). Linear regression demonstrated a significant positive correlation between the HW-PU and creatinine nadir (R 2 = 0.097, p = 0.002). The presence of bilateral reflux is significantly associated with creatinine nadir ≥0.8 mg/dL (p = 0.001). DISCUSSION We investigate for the first time the association of morphology features on the initial VCUG with renal outcome in PUV patients. Posterior urethral deformity as quantified by a higher HW-PU ratio is significantly correlated with a higher creatinine nadir, whereas measured bladder morphology metrics are not. HW-PU may be an indirect measure of the severity of obstruction in posterior urethral valves. CONCLUSION The HW-PU appears to be a meaningful early morphologic metric for renal outcome.
Collapse
|
6
|
Chan MMY, Sadeghi-Alavijeh O, Lopes FM, Hilger AC, Stanescu HC, Voinescu CD, Beaman GM, Newman WG, Zaniew M, Weber S, Ho YM, Connolly JO, Wood D, Maj C, Stuckey A, Kousathanas A, Kleta R, Woolf AS, Bockenhauer D, Levine AP, Gale DP. Diverse ancestry whole-genome sequencing association study identifies TBX5 and PTK7 as susceptibility genes for posterior urethral valves. eLife 2022; 11:74777. [PMID: 36124557 PMCID: PMC9512401 DOI: 10.7554/elife.74777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 08/15/2022] [Indexed: 12/12/2022] Open
Abstract
Posterior urethral valves (PUV) are the commonest cause of end-stage renal disease in children, but the genetic architecture of this rare disorder remains unknown. We performed a sequencing-based genome-wide association study (seqGWAS) in 132 unrelated male PUV cases and 23,727 controls of diverse ancestry, identifying statistically significant associations with common variants at 12q24.21 (p=7.8 × 10-12; OR 0.4) and rare variants at 6p21.1 (p=2.0 × 10-8; OR 7.2), that were replicated in an independent European cohort of 395 cases and 4151 controls. Fine mapping and functional genomic data mapped these loci to the transcription factor TBX5 and planar cell polarity gene PTK7, respectively, the encoded proteins of which were detected in the developing urinary tract of human embryos. We also observed enrichment of rare structural variation intersecting with candidate cis-regulatory elements, particularly inversions predicted to affect chromatin looping (p=3.1 × 10-5). These findings represent the first robust genetic associations of PUV, providing novel insights into the underlying biology of this poorly understood disorder and demonstrate how a diverse ancestry seqGWAS can be used for disease locus discovery in a rare disease.
Collapse
Affiliation(s)
- Melanie MY Chan
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
| | | | - Filipa M Lopes
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
| | - Alina C Hilger
- Children's Hospital, University of BonnBonnGermany
- Institute of Human Genetics, University of BonnBonnGermany
| | - Horia C Stanescu
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
| | - Catalin D Voinescu
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
| | - Glenda M Beaman
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation TrustManchesterUnited Kingdom
- Evolution and Genomic Sciences, School of Biological Sciences, University of ManchesterManchesterUnited Kingdom
| | - William G Newman
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation TrustManchesterUnited Kingdom
- Evolution and Genomic Sciences, School of Biological Sciences, University of ManchesterManchesterUnited Kingdom
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona GóraZielona GoraPoland
| | - Stefanie Weber
- Department of Pediatric Nephrology, University of MarburgMarburgGermany
| | - Yee Mang Ho
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
| | - John O Connolly
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
- Department of Adolescent Urology, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Dan Wood
- Department of Adolescent Urology, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Carlo Maj
- Center for Human Genetics, University of MarburgMarburgGermany
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of BonnBonnGermany
| | - Alexander Stuckey
- Genomics England, Queen Mary University of LondonLondonUnited Kingdom
| | | | | | - Robert Kleta
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
- Nephrology Department, Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - Adrian S Woolf
- Division of Cell Matrix Biology & Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
- Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUnited Kingdom
| | - Detlef Bockenhauer
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
- Nephrology Department, Great Ormond Street Hospital for Children NHS Foundation TrustLondonUnited Kingdom
| | - Adam P Levine
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
- Research Department of Pathology, University College LondonLondonUnited Kingdom
| | - Daniel P Gale
- Department of Renal Medicine, University College LondonLondonUnited Kingdom
| |
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
8
|
Wu CQ, Blum ES, Patil D, Shin HS, Smith EA. Predicting childhood chronic kidney disease severity in infants with posterior urethral valve: a critical analysis of creatinine values in the first year of life. Pediatr Nephrol 2022; 37:1339-1345. [PMID: 34716802 DOI: 10.1007/s00467-021-05271-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Posterior urethral valve (PUV) is a leading cause of chronic kidney failure in children. Studies have shown that a creatinine nadir above historical cutoff values of 0.8 or 1.0 mg/dL correlates with worse kidney outcomes. The ability to use nadir creatinine more discriminately as a test of kidney outcomes is otherwise limited. METHODS We performed a retrospective review of 102 infants treated with primary valve ablation prior to 1 year of age. Patient factors including creatinine at presentation (Cr-P), nadir within 6 weeks after ablation (Cr-6 W), and nadir within 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) severity. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC). Multivariable logistic regression models compared Cr-P, Cr-6 W, and Cr-1Y while adjusting for patient factors. RESULTS Boys were ablated at mean age of 36.3 days and followed for 6.6 years (± 3.7). When compared to other demographics, only creatinine remained independently predictive of CKD outcomes on multivariable analysis. ROC analysis demonstrated excellent diagnostic accuracy for Cr-6 W and Cr-1Y (p < 0.001) and acceptable accuracy for Cr-P (p < 0.005). Using the Cr-6 W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome. CONCLUSIONS The severity of childhood CKD can be predicted with high accuracy using the creatinine nadir within 6 weeks of ablation. The cutoff values described can be incorporated into a clinical setting for patient counseling and individual risk stratification.
Collapse
Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily S Blum
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30328, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - H Stella Shin
- Division of Pediatric Nephrology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30328, USA.
| |
Collapse
|
9
|
Yadav P, Rickard M, Weaver J, Chua M, Kim JK, Khondker A, Milford K, Keefe DT, Lolas M, Dos Santos J, Erdman L, Skreta M, Selman Fermin A, Ashwal E, Viteri B, Ryan G, Tasian G, Lorenzo AJ. Pre-natal vs Post-natal Presentation of PUV: A Multi-institutional Experience. BJU Int 2022; 130:350-356. [PMID: 35142035 DOI: 10.1111/bju.15708] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) at two large pediatric centres in North America to ascertain if the prenatal diagnosis of PUV is associated with better outcomes. MATERIALS AND METHODS All patients with PUV were identified at 2 large pediatric institutions in North America between 2000-2020 (The Hospital for Sick Children [SK] and Children's Hospital of Philadelphia [CHOP]). Baseline characteristics and outcome measures were compared between those diagnosed prenatally vs. postnatally. Main outcomes of interest included progression of chronic kidney disease (CKD), the need for renal replacement therapy (RRT) and bladder function compromise as determined by need for clean intermittent catheterization (CIC). Time-to-event analyses were completed when possible. RESULTS During the study period, 152 patients with PUV were treated at SK (39% prenatal) and 216 patients with PUV were treated at CHOP (71% prenatal). At SK, there was no difference between prenatal and postnatal groups in the proportion of patients who required RRT, progressed to CKD stage 3 and above, or who were managed with CIC when comparing the timing of diagnosis. The time to event for RRT and CIC was significantly younger for prenatally detected PUV. At CHOP, significantly more prenatal patients required RRT, however there was no significant difference in the age this outcome was reached. The proportion of children managed with CIC was not different but the time to event was significantly earlier in the prenatal group. CONCLUSION This study represents the largest multi-institutional series of patients with PUV and failed to identify any difference in the outcomes of prenatal versus postnatal detection of PUV. A multidisciplinary approach with standardization of the treatment pathways will help in understanding the true impact of prenatal/ early detection on outcomes of PUV.
Collapse
Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, 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, Ontario, Canada
| | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adree Khondker
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada
| | - Karen Milford
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada.,Department of Paediatric Surgery, Nelson Mandela Children's Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel T Keefe
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada
| | - Lauren Erdman
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Marta Skreta
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Antoine Selman Fermin
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eran Ashwal
- Ontario Fetal Centre, Dept. of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bernarda Viteri
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Greg Ryan
- Ontario Fetal Centre, Dept. of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
D'Oro A, Meyer T, Gong EM, Rosoklija I, Liu DB. Are pressure pop-offs beneficial to the bladder in boys with posterior urethral valves? J Pediatr Urol 2020; 16:488.e1-488.e8. [PMID: 32605875 DOI: 10.1016/j.jpurol.2020.05.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/13/2020] [Accepted: 05/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pressure pop-offs, such as high-grade vesicoureteral reflux with renal dysplasia, have historically been considered beneficial for renal and bladder outcomes in boys with posterior urethral valves (PUV). Recent longer-term studies have called into question the beneficial effects of pop-offs on renal function. OBJECTIVE To evaluate how pop-offs affect bladder outcomes in boys with PUV. STUDY DESIGN At a single-center, the electronic medical records of boys with PUV who underwent valve ablation from 2000 to 2014 were retrospectively reviewed for bladder and continence outcomes. Patients were excluded due to presentation after one year of age, age at last follow-up <1 year, lack of urodynamic study (UDS), lack of voiding cystourethrogram, or concomitant prune belly syndrome. Between patients with and without pop-offs, the following outcomes were compared: prevalence of significant hydronephrosis (Society for Fetal Urology grade 3 or 4) prior to valve ablation and at last follow-up, nadir creatinine level, classification of initial UDS, type of medical and/or surgical interventions, dryness during the day and toilet-training status at last follow-up (among patients ≥4 years), and age at toilet-training. For patients with multiple UDS, initial and latest UDS were compared. RESULTS 48 patients met inclusion criteria, of whom 31 (65%) had pop-offs and 17 (35%) did not. Median age at last follow-up was 5.9 years (range: 1.0-12.2 years). Patients with pop-offs were more likely to have unsafe initial UDS (26% vs. 12%, p = 0.15) but less likely to have high voiding pressures at their latest UDS (15% vs. 50%, p = 0.03). Patients with pop-offs were more likely to have used clean intermittent catheterization (26% vs. 0%, p = 0.04) and were less likely to be toilet-trained by age 4 (76% vs. 100%, p = 0.15) or dry during the day at last follow-up (56% vs. 92%, p = 0.06). Toilet-trained patients with pop-offs were toilet-trained by an earlier age than patients without pop-offs (3 vs 4 years, p = 0.04). DISCUSSION The results of the present retrospective study show that patients with pop-offs required more extensive interventions to achieve continence, and achieved continence and toilet-training less frequently than patients without pop-offs. Additionally, our results demonstrated that patients with pop-offs had worse bladder dynamics initially, which may suggest that pop-offs are a manifestation of more excessive pressure build-up prior to valve ablation. CONCLUSIONS Among boys with posterior urethral valves who present in the first year of life, pop-offs do not appear to impart significant benefit to bladder outcomes and may indicate more severe bladder dysfunction.
Collapse
Affiliation(s)
- Anthony D'Oro
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Edward M Gong
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Dennis B Liu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL, 60611, USA.
| |
Collapse
|
11
|
Smith L, Kakade M, Rajimwale A. Double trouble: A rare case of posterior urethral valve and Cobb's collar. Urol Case Rep 2019; 24:100848. [PMID: 31211059 PMCID: PMC6562284 DOI: 10.1016/j.eucr.2019.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/13/2019] [Accepted: 02/13/2019] [Indexed: 12/02/2022] Open
Abstract
Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction (BOO) in boys. Cobb's collar, a rare narrowing of the bulbar urethra, is one of the lesser-known causes of congenital urethral obstruction. We present a case of both congenital anomalies occurring concomitantly, in a preterm baby presenting with urinary ascites.
Collapse
Affiliation(s)
- Lee Smith
- Leicester Children's Hospital, Leicester Royal Infirmary, Infirmary Road, Leicester, LE1 5WW, UK
| | - Madhavi Kakade
- Leicester Children's Hospital, Leicester Royal Infirmary, Infirmary Road, Leicester, LE1 5WW, UK
| | - Ashok Rajimwale
- Leicester Children's Hospital, Leicester Royal Infirmary, Infirmary Road, Leicester, LE1 5WW, UK
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Nawaz G, Hussain I, Muhammad S, Jamil MI, Rehman AU, Iqbal N, Akhter S. Justification For Re-Look Cystoscopy After Posterior Urethral Valve Fulguration. J Ayub Med Coll Abbottabad 2017; 29:30-32. [PMID: 28712168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Posterior urethral valve (PUV) is life-threatening congenital anomaly of the urinary tract that results in vesicoureteric reflux, recurrent UTI, voiding dysfunction and renal insufficiency if not treat timely. Endoscopic ablation of posterior urethral valves using cold knife or laser is the current gold standard therapy. Many urologists go for repeat cystoscopy to see residual valve or stricture while others repeat VCUG to measure the posterior to anterior urethral ratio for residual obstruction. In this study, we have standardized by regularly doing re-look cystoscopy at 3 months whether the child is symptomatic or not to see justification for re-look cystoscopy after PUV ablation. METHODS In this prospective study, first 50 cases that underwent posterior urethral valve fulguration were included. Diagnosis of posterior urethral valve was made by voiding symptoms, ultrasonography and confirmed by voiding cysto-urethrogram (VCUG). All children were treated by endoscopic fulguration of posterior urethral valves (PUV) using cold knife as urethral valvotome and were followed clinically for voiding symptoms and with ultrasonography and laboratory test at 3 and 6 months. All patients underwent re-look cystoscopy at three months to see residual valves irrespective of their clinical improvement. RESULTS Mean age at presentation was 4.9±3.2 years. The most common symptoms were poor stream (76%), straining at voiding (72%), dribbling of urine (54%), fever (42%) and urinary retention (14%). Residual valves on re-look cystoscopy were seen in 78%. Four (8%) patients had urethral stricture on re-look cystoscopy. CONCLUSIONS We suggest routine re-look cystoscopy after primary fulguration of PUV to pick more residual obstructive valves.
Collapse
Affiliation(s)
- Gul Nawaz
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Ijaz Hussain
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Shujah Muhammad
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Asad Ur Rehman
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Nadeem Iqbal
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Saeed Akhter
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| |
Collapse
|
14
|
Abdennadher W, Chalouhi G, Dreux S, Rosenblatt J, Favre R, Guimiot F, Salomon LJ, Oury JF, Ville Y, Muller F. Fetal urine biochemistry at 13-23 weeks of gestation in lower urinary tract obstruction: criteria for in-utero treatment. Ultrasound Obstet Gynecol 2015; 46:306-311. [PMID: 25412852 DOI: 10.1002/uog.14734] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the value of fetal urine biochemistry before 23 weeks of gestation in cases of lower urinary tract obstruction (LUTO) to refine prognosis and to select potential candidates for in-utero intervention. METHODS This was a retrospective study including 72 cases of LUTO with fetal urine sampled before 23 weeks and assayed for total protein, β-2-microglobulin, sodium, chloride, calcium, phosphorus, glucose and gamma-glutamyl transpeptidase (GGTP). Two groups were defined according to renal outcome: 1) bilateral renal dysplasia on histological examination or renal failure at birth; 2) normal postnatal renal function or histologically normal appearance of the kidneys. Correlations between fetal urinary biochemical markers and postnatal renal function were studied. RESULTS LUTO was isolated in 56/72 (77.8%) cases and was associated with other malformations in 16/72 (22.2%) cases. High GGTP levels (236 IU/L vs 5 IU/L; P < 0.0001) were observed in fetal urine in the five cases of urodigestive fistula. A significant difference between outcome groups was observed for β-2-microglobulin (P = 0.0017), sodium (P = 0.0008), chloride (P = 0.0028) and calcium (P = 0.0092) but not for protein, glucose or phosphorus. Sensitivity and specificity in defining a poor renal prognosis were 80.6% and 89% for β-2-microglobulin, 61.3% and 100% for sodium and 64.5% and 100% for calcium, respectively. CONCLUSIONS Fetal urinalysis before 23 weeks of gestation allowed distinction between three groups: 1) fetuses with normal urine biochemistry for which fetal therapy should be discussed; 2) fetuses with abnormal urine biochemistry for which prognosis for renal outcome is poor and for which the benefit of fetal therapy is likely to be compromised; 3) fetuses with urodigestive fistula.
Collapse
Affiliation(s)
- W Abdennadher
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - G Chalouhi
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - S Dreux
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
| | - J Rosenblatt
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - R Favre
- Department of Obstetrics and Gynaecology, CMCO, Schiltigheim, France
| | - F Guimiot
- Department of Developmental Biology, Hôpital Robert Debré, APHP, Paris, France
| | - L J Salomon
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - J F Oury
- Department of Obstetrics and Gynaecology, Hôpital Robert Debré, APHP, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, Hôpital Necker Enfants Malades, APHP, Paris, France
| | - F Muller
- Department of Biochemistry, Hôpital Robert Debré, APHP, Paris, France
| |
Collapse
|
15
|
Mirshemirani A, Khaleghnejad A, Rouzrokh M, Sadeghi A, Mohajerzadeh L, Sharifian M. Posterior Urethral Valves; A single Center Experience. Iran J Pediatr 2013; 23:531-5. [PMID: 24800012 PMCID: PMC4006501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/15/2013] [Indexed: 10/29/2022]
Abstract
OBJECTIVE Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction in infancy that impair renal and bladder function. This study was planned to evaluate and record the various clinical presentations and management, complications, and surgical management and long-term outcome of PUV. METHODS In a retrospective study, 98 patients who have been treated for PUV are evaluated in Mofid Children's Hospital from January 2007 to December 2012. Detailed history taken and paraclinical examinations were performed in each patient and diagnosis was confirmed by voiding-cysto-urethrography (VCUG). PUV had been ablated in 62 patients by electric hook, and diversion was performed in 42 (42.85%) cases. Data were analyzed by SPSS software version18. FINDINGS Totally 98 patients with mean age at diagnosis 62 (±13) days were included in this study. Fifty seven cases had been catheterized within one to 6 days of life (mean age one day), PUV was ablated in 62 patients by electric hook, and diversion was performed in 42 cases. The most common symptom in our group was dribbling poor stream 51% and urinary tract infection (UTI) 40.8%. There was vesico-ureteral-reflux (VUR) in 61.2%, and hydronephrosis in 82.6%. Most common associated anomaly was kidney anomalies (multicystic kidney disease and renal agenesis/dysplasia) in 8 (8.2%) patients. Twenty patients had prenatal diagnosis of PUV. Complication occurred in three (3.1%) patients. Mortality occurred in 5 (5.1%) patients. Mean follow-up period was 3.4±1.2 years (1.5 months to 5 years). CONCLUSION Urinary drainage by feeding tube in early days of infancy, followed by valve ablation is the best treatment in PUV, and urinary diversion improves the outcome. VCUG is still the gold-standard imaging modality for documenting PUVs. The factors like renal dysplasia and UTI have their role in final outcome.
Collapse
Affiliation(s)
- Alireza Mirshemirani
- Pediatric Surgery Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author:Address: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail:
| | - Ahmad Khaleghnejad
- Pediatric Surgery Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rouzrokh
- Pediatric Surgery Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghi
- Department of Pediatric Anesthesiology, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Mohajerzadeh
- Pediatric Surgery Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Mustafa Sharifian
- Pediatric Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Jalkanen J, Mattila AK, Heikkilä J, Roine RP, Sintonen H, Taskinen S. The impact of posterior urethral valves on adult quality of life. J Pediatr Urol 2013; 9:579-84. [PMID: 22878058 DOI: 10.1016/j.jpurol.2012.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the quality of life of men who had been treated for posterior urethral valves (PUV) in childhood. PATIENTS AND METHODS Questionnaires were mailed to 108 patients with PUV treated at the Children's Hospital, University of Helsinki, and 67 (62%) of them responded. Three different questionnaires (15D, LSS, and RAND) were used to evaluate the quality of life. RESULTS The total quality of life in PUV patients was reported as good compared to the general population in the RAND and LSS surveys. However, in the 15D analysis the PUV patients reported lower scores in sleeping, eating, and sexual activity. Those PUV patients who had been treated for renal insufficiency reported lower scores in several dimensions in all three surveys. Patients with urinary incontinence reported more sleeping problems and regarded themselves physically more disabled. CONCLUSIONS The PUV patients with renal insufficiency or urinary incontinence had impaired quality of life in several dimensions.
Collapse
Affiliation(s)
- Jenni Jalkanen
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | | | | | | | | |
Collapse
|
17
|
Lloyd JC, Wiener JS, Gargollo PC, Inman BA, Ross SS, Routh JC. Contemporary epidemiological trends in complex congenital genitourinary anomalies. J Urol 2013; 190:1590-5. [PMID: 23791903 DOI: 10.1016/j.juro.2013.04.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Anecdotal evidence suggests that complex congenital genitourinary anomalies are occurring less frequently. However, few epidemiological studies are available to confirm or refute this suggestion. MATERIALS AND METHODS The Kids' Inpatient Database (KID) is a national, all payer database of several million inpatient pediatric hospitalizations per year, including complicated and uncomplicated in-hospital births. We reviewed the 1997 to 2009 KID to determine the birth prevalence of spina bifida, posterior urethral valves, bladder exstrophy, epispadias, prune belly syndrome, ambiguous genitalia and imperforate anus. For posterior urethral valves and prune belly syndrome we limited our search to newborn males only. RESULTS During the study period, there was a diagnosis of spina bifida in 3,413 neonates, bladder exstrophy in 214, epispadias in 1,127, ambiguous genitalia in 726, prune belly syndrome in 180, posterior urethral valves in 578 and imperforate anus in 4,040. We identified no significant change in the birth prevalence of spina bifida (from 33.9 new spina bifida births of 100,000 uncomplicated births to 29.0/100,000, p = 0.08), posterior urethral valves (from 10.4/100,000 to 11.0/100,000, p = 0.51), prune belly syndrome (from 4.8/100,000 to 3.3/100,000, p = 0.44) or ambiguous genitalia (from 5.82/100,000 to 5.87/100,000, p = 0.38). There was a significant decrease in the birth prevalence of bladder exstrophy (from 2.4/100,000 to 1.6/100,000 uncomplicated births, p = 0.01) and a significant increase in epispadias (from 8.0/100,000 to 11.6/100,000) and imperforate anus (from 33.6/100,000 to 35.0/100,000, each p = 0.04) during the study period. CONCLUSIONS The birth prevalence of spina bifida, posterior urethral valves and prune belly syndrome appears to have been stable in the last 12 years. Epispadias, ambiguous genitalia and imperforate anus diagnoses in newborns became more common in the same period, while bladder exstrophy diagnoses became less common.
Collapse
Affiliation(s)
- Jessica C Lloyd
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Urology, University of Texas Southwestern Medical Center (PCG), Dallas, Texas.
| | | | | | | | | | | |
Collapse
|
18
|
Shriver S, Yang W, Chung SY, Percival S. Pulsed ultraviolet light reduces immunoglobulin E binding to Atlantic white shrimp (Litopenaeus setiferus) extract. Int J Environ Res Public Health 2011; 8:2569-83. [PMID: 21845146 DOI: 10.3390/ijerph8072569] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/19/2011] [Indexed: 11/17/2022]
Abstract
Pulsed ultraviolet light (PUV), a novel food processing and preservation technology, has been shown to reduce allergen levels in peanut and soybean samples. In this study, the efficacy of using PUV to reduce the reactivity of the major shrimp allergen, tropomyosin (36-kDa), and to attenuate immunoglobulin E (IgE) binding to shrimp extract was examined. Atlantic white shrimp (Litopenaeus setiferus) extract was treated with PUV (3 pulses/s, 10 cm from light source) for 4 min. Tropomyosin was compared in the untreated, boiled, PUV-treated and [boiled+PUV]-treated samples, and changes in the tropomyosin levels were determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). IgE binding of the treated extract was analyzed via immunoblot and enzyme-linked immunosorbent assay (ELISA) using pooled human plasma containing IgE antibodies against shrimp allergens. Results showed that levels of tropomyosin and IgE binding were reduced following PUV treatment. However, boiling increased IgE binding, while PUV treatment could offset the increased allergen reactivity caused by boiling. In conclusion, PUV treatment reduced the reactivity of the major shrimp allergen, tropomyosin, and decreased the IgE binding capacity of the shrimp extract.
Collapse
|