The long term renal and bladder function outcomes of patients with posterior urethral valve

Abstract

We aimed to evaluate the preoperative and postoperative renal and bladder functions of patients operated for posterior urethral valve (PUV). Thirty five patients operated for PUV between 2006 and 2016 (mean 94 days, range 4 days12 years). Seven patients had prenatal diagnosis. Preoperative and postoperative serum creatinine, Dimercaptosuccinic acid (DMSA), Voiding cystourethrography (VCUG), recurrent urinary tract infection, additional surgical procedures and urodynamic study results were evaluated. No vesicoureteral reflux (VUR) was demonstrated in four patients. No VCUG is obtained in two patients. Most of the bilateral VUR cases were grade IV or more. Thirteen patients had significant neuropathic bladder findings on VCUG and 21 had dilatation of posterior urethra. There were no preoperative DMSA scintigraphy in nine patients. Twenty two patients had a history of recurrent urinary tract infection. Nine of them had high grade reflux and seven of them had worsening of DMSA function with scars at postoperative follow-up. Preoperative/postoperative creatinine levels were 0.94mg/dL (0.14-4.63) / 0.39 mg/dL (0.11-2.3) respectivel. Five patients are on CIC (3 had Mitrofanoff conduit). Two patients underwent augmentation+Mitrofanoff and one patient had Mitrofanoff procedures. One underwent bilateral ureterostomy and one unilateral ureterostomy (undiversion at five years). Three received percutaneous vesicostomy procedure and one diverged to permanent vesicostomy. Seven has ESRD and two patients are on continous peritoneal dialysis. Postoperative UTI encountered in 22. Forty-two sessions of subureteric injection (17 right, 14 left, 11 bilateral) were performed. Urodynamic study conducted in 27 patients; 14 diagnosed as neuropathic bladder and 9 had DSD. Low bladder capacity and compliance was encountered in 17. Posterior urethral valve is the most important infravesical urinary obstruction that causes deterioration of renal function and permanent damage in boys in terms of long-term outcomes. Life long follow-up is obligate to protect from renal failure. 

Keywords

• Bladder disfunction,Posterior urethral valve,Renal function,Valve bladder

References

1. Abdenanadher W, Chalouhi G, Dreux S., 2015. Fetal urine biochemistry at 13-23 weeks of getation in lower urinary tract obstruction: Criteria for in-utero treatment. Ultrasound Obstet Gynecol. 46(3): 306-311.
2. Abraham MK, Nasir AR, Sudarsanan B, Puzhankara R, Kedari PM, Unnithan GR., 2009. Role of alpha adrenergic blocker in the management of posterior urethral valves. Pediatr Surg Int 25: 1113-1115.
3. Berte N, Vrillon I, Larmure O, Gomola V, Ayav C, Mazeaud C, Lemelle JL.., 2018 Long-term renal outcome in infants with congenital lower urinary tract obstruction. Prog Urol. Oct; 28 (12): 596-602.
4. Bhadoo D, Bajpai M, Panda SS., 2014. Posterior urethral valve: Prognostic factors and renal outcome. J Indian Assoc Pediatr Surg. 19(3): 133-137.
5. Bhatnagar V, Agarwala S, Lal r, Mitra DK., 2000. Fulguration of posterior urethral valves using the Nd: YAG laser. Pediatr Surg ınt. 16: 69-71.
6. Bilgutay an, Roth DR, Gonzales ET, Janzen Nicolette, Zhang W, Koh cj, Gargollo P, Seth A., 2016. Posterior urethral valves: Risk factors for progression to renal failure. J Pediatr urol. 12: 179e1-179e7.
7. Binghamn JB, Maisey MN., 1978. An evolution of the use of 99-Tc dimercaptosuccinic acid (DMSA) as a static renal imaging agent. Br J Urol. 51:599-602.
8. Borzi PA, Beasley SW, Fpwler R., 1992. Posterior urethral valves in non twin siblings. Br J Urol. 70:201.

9. Canning DA., 2019. Bladder contractility index in posterior urethral valves: A new marker early prediction of progression to renal failure. J Urol. May, 201(5): 846.
10. Farnsworth RH, Rossleigh MA, Leighton DM, Bass SJ, Rosenberg AR., 1991. The detection of reflux nephropathy in infants by 99-Tc dimercaptosuccinic acid (DMSA) studies. J Urol. 145: 542-546.
11. Fine ms, Smith KM, Shrivastava D, Cook ME, Shukla AR., 2011. Posterior urethral valve treatments and outcomes in children receiving kidney transplants. J Urol 185 (6 suppl): 2507-2511.
12. Fumo MJ, Mclorie GA., 2006. Management of the valve-bladder syndrome and congenital bladder obstruction: the role of nocturnal bladder drainage. Nat Clin Pract Urol. 3: 323-326.
13. Gordon I, Riccabona M., 2003. Investigation the newborn kidney: Update on imaging techniques. Semin Neonatal. 8:269-278.
14. Hebenstreit D, Csaicich D, Hebenstreit k, Müller-Sacherer T, Berlakovich G, Springer A., 2018. Long-term outcome of pediatric renal transplantation in boys with posterior urethral valves. J Urol. Nov, 53(11): 2256-2260.
15. Heikkila J, Holmberg C, Kyllonen L, Rintala R, Taskinen S., 2011. Long-term risk of end stage renal disease in patients with posterior urethral valves. J Urol. 186(6): 2392-2396.
16. Hennus PM, Heijden GJM, Bosch JL, Jong TPV, Kort LMO., 2012. A systematic review on renal and blladder dysfunction after endoscopic treatment of ınfravesical obstruction in boys. Plos One. Sep; 7(9): e44663 (1-8).
17. Holmdahl G, Sillen U, Hellstrom AL, Sixt R., 2003. Does treatment with clean intermittent catheterization in boys with posterior urethral valves affect bladder and renal function ?. J Urol 170: 1681-1685.
18. Holmdahl G, Sillen U., 2005. Boys with urethral valves: Outcome concerning renal function, bladder function and paternity at ages 31 to 44 years. J Urol. 174(3): 1031-1034.
19. Hosseini SM, Zarenezhad M, Kamali M, Gholamzadeh S, Sabet B, Alipour F., 2015. Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve. Afr J Pediatr Surg. Oct-Dec; 12(4):270-272.
20. Jesus LE, Pippi S., 2015. Pre-transplant management of valve bladder: a critical literature review. J Pediatr Urol. Feb, 11(1): 5-11.
21. Jonkisz DP, Rehan LR, Fornalcyzk K, Hackemer P, Zwolinska D., 2017. Valve bladder syndrome in children: On the trail of the best strategies to prevent chronic kidney disease. Adv Clin Exp Med. 26(8): 1293-1300.
22. Joseph DB., 2000. Editorial: Posterior urethral valve and the 11th commandment. J Urol. 164: 149-150.
23. Kari JA, Desoky S, Farag Y, Mosli H, Altyieb A, Sayad A, Radawi O, Ghabra H, Basnawi F, Bahrawi O., 2013. Renal impairment in children with posterior urethral valves.
24. Kim YH, Horowitz M, Combs AJ, Nitti VW, Borer J, Glassberg KI., 1997. Managment of posterior urethrral valves on the basis of urodynamic findings. J Urol. 158: 1011-1016.
25. Krahn CG, Johnson HW., 1993. Cutaneous vesicostomy in the young child: Indications and results. Urology. 41:558-563.
26. Koff SA, Mutabagani KH, Jayanti VR., 2002. The valve bladder syndrome: Pathophysiology and treatment with nocturnal bladder emptying. J Urol. 167: 291-297.
27. Liard A, Seguier-Lipszyc E, Mitrofanoff P., 2000. Temporary high diversion for posterior urethral valves. J Urol. 164: 145-148.
28. Lipitz S, Samuell C., 2016. Fetal urine analysis fort he assesment of renal function in obstructive uropathy. Am j Obstet Gynecol. 168: (1pt1):174-179.
29. Long CJ, Bowen DK., 2018. Predicting and modifiying risk for development of renal failure in boys with posterior urethral valves. Current Urolog Rep. 19(55): 1-6.
30. Narasimhan KL, Chowdhary SK, Kaur B, Mittal BR, Bhattacharya A., 2006. Factors affecting renal scarring in posterior urethral valves. J Pediatr Urol. 2: 569-574.
31. Nasir AA, Ameh EA, Abdur-Rahman LO, Adeniran JO, Abraham MK., 2011. Posterior urethral valve. World J Pediatr. Aug; 7(3): 205-216.
32. Pereira L, Espinosa L, Martinez UMJ, Lobato R, Navarro M, Jaureguizar E., 2003. Posterior urethral valves: Prognostic factors. BJU Int. 91: 687-690.
33. Puri A, Grover VP, Agarwala S, Mitra DK, Bhatnagar V., 2002. Inıtial surgical treatment as determitant of bladder dysfunction in posterior urethral valves. Pediatr Surg Int. Sept, 18 (5-6): 438-443.
34. Smith GH, Canning DA, Schulman SL., 1996. The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol. 155:1730-1734.
35. Smith-Harrison LI, Hougen HY,Timberlake MDCorbett ST., 2015. Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol. 11(6): 341-347
36. Spaggiari E, Faure G, Dreux S, Czerkiewicz I, Strinemann JJ, Guimmiot F, Heidet L, Favre R., 2017. Sequential fetal serum Beta 2 microglobulin to predict postnatal renal function bilateral or lower urinary tract obstruction. Ultrasound Obstet Gynecol. May; 49(5): 617-622.
37. Sweeney I, Kang BH, Lin P, Giovanniello J., 1981. Posterior urethral obstruction caused by congenital posterior urethral valve: Prenatal and postnatal ultrasound diagnosis. N Y State J Med. Jan;81(1): 87-89.
38. Taskinen S, Heikkila J, Rintala R., 2012. Effects of posterior urethral valves on long-term bladder and sexual function. Urology. Dec; 9: 699-706.
39. Thomas DFM., 2007. Prenatally diagnosed urinary tract abnormalities: Long-term outcome. Semin Fetal Neonatal Med. 13(3): 189-195.
40. Tourchi A, Kaibahzadeh AM, Aryan Z, Ebadi M., 2014. The management of vesicoreteral reflux in the setting of posterior urethral valve with emphasis on bladder function and renal outcome. Single center cohort study. Urology. Jan; 83(1): 199-205.