Prognostic factors of posterior urethral valves and the role of antenatal detection.
The aim of the study was to investigate the significance of different prognostic factors and long-term renal outcome in boys with posterior urethral valves (PUVs) detected either antenatally or during infancy. A total of 46 cases of PUVs, 23 antenatal and 23 postnatal, were followed prospectively from 1983 to 2003. The mean follow-up time was 12.5 years. The impact of vesicoureteral reflux (VUR), urinary tract infections (UTIs), urinary continence, and renal parenchymal damage on patient outcome was evaluated. Long-term renal outcome was defined as favorable if renal function was either normal or moderately impaired (glomerular filtration rate > or = 60 ml/min per 1.73 m(2)) and poor if the patient had either chronic renal failure or end-stage renal disease. The outcome was poor in 14 (30%) of the 46 boys and was associated with a significantly higher nadir serum creatinine concentration (mean 157 micromol/l) during the 1st year of life ( P<0.001), with bilateral VUR ( P<0.05) and breakthrough UTIs ( P<0.05). In our patients, age at achieving urinary continence, and the presence of renal parenchymal damage did not have a statistically significant association with long-term renal outcome. The long-term outcome among boys with antenatally detected PUVs did not differ from that among those cases detected postnatally after developing symptoms ( P=0.25).
Ylinen
Elisa
E
Hospital for Children and Adolescents, University of Helsinki, PO Box 281, 00029 HUS, Helsinki, Finland. elisa.ylinen@helsinki.fi
Ala-Houhala
Marja
M
Wikström
Sakari
S
D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D016216:Ultrasonography, Prenatal; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging*