Long-term Follow Up of Posterior Urethral Valve Patients and Predictors of Outcome, Cairo University Specialized Pediatric Hospital

Shouman, Ahmed M; Elgharably, Mohamed AboulFotouh; El Fayoumy, Hany; El Rahman, SherifAbd; Ghoneima, Waleed; Abd El Wahab, Mohamed; Shoukry, Ahmed

doi:10.21608/ejhm.2022.274799

Long-term Follow Up of Posterior Urethral Valve Patients and Predictors of Outcome, Cairo University Specialized Pediatric Hospital

Document Type : Original Article

Authors

10.21608/ejhm.2022.274799

Abstract

Background: Posterior urethral valves (PUVs) are reported to occur in 1/5000-8000 live births. It represents the most frequent cause of bladder outlet obstruction in children and is associated with significant morbidities and even mortality.
Objective:The aim of the current study is to record thelong-term follow up of posterior urethral valve (PUV) patients and the effect of different predictors on outcome.
Patients and methods:A total of30 boys with PUV initially presented between January 2010 and December 2018 and strictly fulfilled our follow up protocol. We collected their data retrospectively; the last follow-up data were recorded and analyzed.
Results:Median age at presentation was 6.3 monthsand mean age at last follow-up 5.67 ± 2.78 years, duration of follow up was 1.8-10 years. Lower urinary tract dysfunction (LUTD) was present in 19 boys (63%). 10 patients (33%) developed chronic renal failure at the last follow-up. Vesicoureteric reflux was a risk factor for occurrence of LUTD (p=0.007). Diurnal incontinence was a predictor for both upper and lower urinary tract dysfunction (p=0.011), (p=0.004) respectively. Mean value of Nadir serum creatinine was increased in patients with renal impairment (p < 0.001), makes it a good predictor of future renal function with a cut-off value of 0.75 mg/dl. With a cut-off value of 2.28, the posterior/anterior urethra ratio was a good predictor for the success of PUV ablation (p < 0.001). SWRD score > 4 statistically correlated with upper tract deterioration (p < 0.005) but not to LUTD.
Conclusions:Daytime dribbling and significant post voiding urine volumes were predictors of poor outcome. Nadir serum creatinine with a cut-off value of 0.75 mg/dl was a good predictor of future renal function. Also with a cut-off value of 2.28, the posterior/anterior urethra ratio was a good predictor for the success of PUV ablation.

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