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 days-12 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. © 2020 OMU