Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation.
OBJECTIVE
Management of posterior urethral valves is significantly modified by the prenatal diagnosis. Our aim was to assess long-term outcome of children with prenatally detected posterior urethral valves treated at our institution by primary valve ablation without routine urinary drainage or diversion.


METHODS
A total of 79 cases of posterior urethral valves were detected prenatally at our hospital between 1987 and 2004. Of these cases 65 were managed postnatally, while pregnancy was terminated in 14. We studied the prenatal parameters of gestational age at diagnosis, renal parenchyma on ultrasound and amniotic fluid volume. Fetal urine was analyzed when indicated. Long-term outcome was assessed.


RESULTS
Primary valve ablation was done in all cases except 2. Median followup was 6.8 years (range 1 to 14.3). At the end of followup there were 11 cases of renal failure (17%) with 5 detected before 24 weeks of gestation, 6 cases of oligohydramnios and 9 cases of abnormal parenchyma. Gestational age at diagnosis and oligohydramnios were statistically significant predictors of final renal outcome (p = 0.003 and p = 0.02, respectively), while renal parenchymal changes were not (p = 0.23). When fetal urinalysis detected good prognosis (12 cases) renal failure developed in none, compared to 2 of the 3 cases with a bad prognosis. Continence was achieved in 42 of 55 toilet trained children (76%), 3 had nocturnal enuresis and 10 (18%) were incontinent.


CONCLUSIONS
Our long-term results of prenatally detected posterior urethral valves confirm that early valve ablation can be considered as the primary treatment in the majority of patients, without the need for preoperative drainage or diversion. Gestational age at diagnosis and volume of amniotic fluid are significant predictors of postnatal renal outcome.
Sarhan
Osama
O
Service de Chirurgie et Urologie Pédiatrique, Université Paris 7, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
Zaccaria
Isabelle
I
Macher
Marie-Alice
MA
Muller
Francoise
F
Vuillard
Edith
E
Delezoide
Anne-Lise
AL
Sebag
Guy
G
Oury
Jean-Francois
JF
Aigrain
Yves
Y
El-Ghoneimi
Alaa
A
D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods