Normal growth with renal insufficiency owing to posterior urethral valves: value of long-term diversion. A twenty-year follow-up.
Twenty-five patients with posterior urethral valves have been monitored for 10-29 years (mean 18 years). Eight underwent diversion because of impaired renal function (creatinine greater than 0.8 mg/dl) accompanied by unimproved upper tract form and function after valve ablation. In the nondiverted group, 6 patients (35%) progressed to renal failure; in the diverted group 5 patients (63%) did so (p = 0.30). Of 13 patients whose lowest serum creatinine in the first year after valve ablation was greater than 0.8 mg/dl, 9 (69%) went on to renal failure (p = 0.02); in the remaining 12 patients, only 2 (17%) did so (p = 0.008). The mean age for renal failure was 13 years for both groups. The Tanner scale rating (mean percent height) for all patients at 10 years was 61% for the diverted group and 35% for those without diversion (p = 0.004). When the patients treated after the age of 1 year (n = 7) were excluded from the calculation, the rating remained different (54% diversion, 26% no diversion; p = 0.012). We conclude that the boy born with urethral valves and serious upper tract damage is at risk for renal failure, especially during the teen years. An undefined relationship appears to exist between urinary obstruction and growth. In our study, the boys who underwent diversion continued to grow along a normal Tanner height curve.
Lyon
R P
RP
Department of Urology, University of California School of Medicine, San Francisco 94143-0738.
Marshall
S
S
Baskin
L S
LS
D000293:Adolescent; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014521:Urethra / Q000002:abnormalities*; D014524:Urethral Obstruction / Q000151:congenital* / Q000601:surgery; D014547:Urinary Diversion