Predicting and Modifying Risk for Development of Renal Failure in Boys with Posterior Urethral Valves

Pediatric Urology (D Weiss, Section Editor)
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  1. Topical Collection on Pediatric Urology

Abstract

Purpose of Review

The purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk.

Recent Findings

Renal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss. Refinement of urine studies may improve our ability to stratify patients into renal loss categories. Use of videourodynamics (VUDS) allows refined assessment of the valve bladder to identify those who might benefit from secondary procedures and/or the addition of targeted pharmacotherapy to improve bladder emptying or dangerous storage pressures.

Summary

All boys with a history of PUV are at a significant long-term risk of renal deterioration. The literature suggests that several technical advances have improved our ability to predict this risk, although there needs to be further refinement and validation before widespread use. Utilization of close follow-up, VUDS, pharmacotherapy, and bladder drainage provide the best methods to improve care to this group of patients and if more studies confirm their utility, adoption of these as part of standard of care protocols may be warranted.

Keywords

Posterior urethral valves Renal insufficiency Anticholinergic Ultrasound 

Abbreviations

PUV

Posterior urethral valves

LUTO

Lower urinary tract obstruction

RBUS

Renal bladder ultrasound

RPA

Renal parenchymal area

ESRD

End-stage renal disease

CKD

Chronic kidney disease

BN

Bladder neck

ACE-I

Angiotensin-converting enzyme-inhibitors

CMD

Corticomedullary differentiation

VUR

Vesicoureteral reflux

VCUG

Voiding cystourethrography

Notes

Compliance with Ethical Standards

Conflict of Interest

Christopher J. Long and Diana K. Bowen each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of UrologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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