Management of urinary extravasation in 18 boys with posterior urethral valves.
OBJECTIVE
Urinary extravasation with associated posterior urethral valves is uncommon and published articles are restricted to case reports. We propose a management algorithm on the basis of presentation of 18 boys with this condition.


METHODS
In this retrospective review we analyze the clinical features, diagnostic radiological imaging (voiding cystourethrogram and (99m)technetium mercaptoacetyltriglycine scan) and measured glomerular filtration rate (GFR) for assessment of renal function in boys presenting with posterior urethral valves and urinary extravasation. Indications for surgical intervention and long-term outcome were evaluated. Results are presented as mean +/- SD.


RESULTS
Patient age at presentation was 4 days (range 1 to 28). Salient features at presentation were abdominal distention in 55.5% of cases, flank mass in 55.5%, respiratory distress in 16.6% and septicemia in 22.2%. Patients were categorized into group 1 with ascites (6 boys) and group 2 without ascites (12). Followup was 70.8 +/- 5.6 months. In group 1 the 3 boys with ascites alone had a followup GFR of 29 versus 74 ml. per minute per 1.73 m.2 in 3 with urinoma plus ascites (p = 0.001) at 64 +/- 4.9 months. In group 2 the GFR in 3 boys with bilateral urinoma was 104.7 +/- 30.4 versus 54.3 +/- 29.4 ml. per minute per 1.73 m.2 in the other 9 with unilateral urinoma (p = 0.001) at 36 +/- 4.2 and 81.3 +/- 4.7 months, respectively. The ipsilateral kidney showed reduced function in 6 of 12 boys with unilateral urinoma from both groups.


CONCLUSIONS
Renal function on the side of the urinoma is impaired, and the majority of patients have impaired global renal function. A management algorithm is proposed.
Patil
K K
KK
Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Wilcox
D T
DT
Samuel
M
M
Duffy
P G
PG
Ransley
P G
PG
González
Ricardo
R
D000465:Algorithms; D001201:Ascites / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007677:Kidney Function Tests; D008297:Male; D014521:Urethra / Q000002:abnormalities; D014524:Urethral Obstruction / Q000151:congenital* / Q000175:diagnosis; D014556:Urine