title: Delayed presentation in posterior urethral valve: long-term implications and outcome.
abstract: OBJECTIVE
  To analyze the effect of delayed presentation of posterior urethral valves in children.
  
  
  METHODS
  We divided 194 children with posterior urethral valve (PUV) who underwent surgical ablation into group I (less than 2 years old) and group II (greater than 2 years old) according to age at presentation. We analyzed the data for the effect of various parameters on post-valve fulguration long-term outcomes.
  
  
  RESULTS
  Groups I and II had 95 and 99 children, respectively. Poor urinary stream or crying during micturition was the most common presenting complaint (96%) in both groups. A total of 32.6% and 81.8% patients had azotaemia at the time of diagnosis in groups I and II, respectively (P <0.001). Mean serum creatinine was 1.68 mg% and 4.1 mg% in groups I and II, respectively (P <0.05). Primary valve ablation was performed in 85.5% patients. After valve ablation, voiding improved in 86.1% and 20.4% patients in groups I and II, respectively (P = 0.001). At a mean follow-up of 9.8 years, 30.5% and 40.8% patients developed renal insufficiency in groups I and II, respectively (P <0.05). Serum creatinine level at 1 year after valve ablation and at presentation was the main prognostic factor for groups I and II, respectively, whereas persistence of VUR and voiding dysfunction after valve ablation reflected poor prognosis for both groups.
  
  
  CONCLUSIONS
  Patients with PUV presenting after 2 years should be treated with caution because the condition is potentially hazardous and these patients are at a higher risk of developing chronic renal insufficiency on long-term follow-up.
authors.affiliation: Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. ansarimsa@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Ansari
authors.forename: Pratipal
authors.initials: P
authors.lastname: Singh
authors.forename: Anil
authors.initials: A
authors.lastname: Mandhani
authors.forename: Deepak
authors.initials: D
authors.lastname: Dubey
authors.forename: Aneesh
authors.initials: A
authors.lastname: Srivastava
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kapoor
authors.forename: Anant
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*