Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors of posterior urethral valves and the role of antenatal detection

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

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 ≥60 ml/min per 1.73 m2) 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 μmol/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).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Duckett JW (1974) Current management of posterior urethral valves. Urol Clin North Am 1:471–483

    PubMed  Google Scholar 

  2. Agarwal S (1999) Urethral valves. BJU Int 84:570–578

    Article  CAS  PubMed  Google Scholar 

  3. Smith GHH, Duckett JW (1996) Urethral lesions in infants and children. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JW (eds) Adult and pediatric urology, 3rd edn. Mosby, St. Louis, Missouri, pp 2411–2444

  4. Cendron M, Elder JS, Duckett JW (1996) Perinatal urology. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JW (eds) Adult and pediatric urology, 3rd edn. Mosby, St. Louis, Missouri, pp 2075–2170

  5. Nakayama DK, Harrison MR, Lorimier AA de (1986) Prognosis of posterior urethral valves presenting at birth. J Pediatr Surg 21:43–45

    CAS  PubMed  Google Scholar 

  6. Churchill BE, McLorie GA, Khoury AE, Merguerian PA, Houle A-M (1990) Emergency treatment and long-term follow-up of posterior urethral valves. Urol Clin North Am 17:343–360

    CAS  PubMed  Google Scholar 

  7. Dinneen MD, Dhillon HK, Ward HC, Duffy PG, Ransley PG (1993) Antenatal diagnosis of posterior urethral valves. Br J Urol 72:364–369

    CAS  PubMed  Google Scholar 

  8. Reinberg Y, Castano I de, Gonzales R (1992) Prognosis for patients with prenatally diagnosed posterior urethral valves. J Urol 148:125–126

    CAS  PubMed  Google Scholar 

  9. El-Ghoneimi A, Desgrippes A, Luton D, Macher M-A, Guibourdenche J, Garel C, Muller F, Vuillard E, Lottmann H, Nessmann C, Oury J-F, Aigrain Y (1999) Outcome of posterior urethral valves: to what extent is it improved by prenatal diagnosis? J Urol 162:849–853

    CAS  PubMed  Google Scholar 

  10. Jee LD, Rickwood AMKMK, Turnock RR (1993) Posterior urethral valves. Does prenatal diagnosis influence prognosis? Br J Urol 72:830–833

    CAS  PubMed  Google Scholar 

  11. Tejani A, Butt K, Glassberg K, Price A, Gurumurthy K (1986) Predictors of eventual end stage renal disease in children with posterior urethral valves. J Urol 136:857–860

    CAS  PubMed  Google Scholar 

  12. Parkhouse HF, Barratt TM, Dillon MJ, Duffy PG, Fay J, Ransley PG, Woodhouse RJ, Williams DI (1988) Long-term outcome of boys with posterior urethral valves. Br J Urol 62:59–62

    CAS  PubMed  Google Scholar 

  13. Denes ED, Barthold JS, Gonzales R (1997) Early prognostic value of serum creatinine levels in children with posterior urethral valves. J Urol 157:1441–1443

    CAS  PubMed  Google Scholar 

  14. Hutton KAR, Thomas DFM, Davies BW (1997) Prenatally detected posterior urethral valves: qualitative assessment of second trimester scans and prediction of outcome. J Urol 158:1022–1025

    CAS  PubMed  Google Scholar 

  15. Hoover DL, Duckett JW Jr (1982) Posterior urethral valves, unilateral reflux and renal dysplasia: a syndrome. J Urol 128:994–997

    CAS  PubMed  Google Scholar 

  16. Rittenberg MH, Hulbert WC, Snyder HM, Duckett JW (1988) Protective factors in posterior urethral valves. J Urol 140:993–996

    CAS  PubMed  Google Scholar 

  17. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE (1985) International system of radiographic grading of vesicoureteral reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109

    CAS  PubMed  Google Scholar 

  18. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    CAS  PubMed  Google Scholar 

  19. Heilbron DC, Holliday MA, al-Dahwi MA, Kogan BA (1991) Expressing glomerular filtration rate in children. Pediatr Nephrol 5:5–11

    CAS  PubMed  Google Scholar 

  20. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39: S1–S266

    Article  PubMed  Google Scholar 

  21. Task Force on Blood Pressure Control in Children (1987) Report of the Second Task Force on Blood Pressure Control in Children-1987. Pediatrics 79:1–25

    Google Scholar 

  22. Smith GHH, Canning DA, Schulman SL, Snyder HM, Duckett JW (1996) The long term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol 155:1730–1734

    CAS  PubMed  Google Scholar 

  23. Warshaw BL, Hymes LC, Trulock TS, Woodard JR (1985) Prognostic features in infants with obstructive uropathy due to posterior urethral valves. J Urol 133:240–243

    CAS  PubMed  Google Scholar 

  24. Hutton KAR, Thomas DFM, Irving AHC, Smith SEW (1994) Prenatally detected posterior urethral valves: is gestational age at detection a predictor of outcome? J Urol 152:698–701

    CAS  PubMed  Google Scholar 

  25. Lal R, Bhatnagar V, Mitra DK (1999) Long-term prognosis of renal function in boys treated for posterior urethral valves. Eur J Pediatr Surg 9:307–311

    CAS  PubMed  Google Scholar 

  26. Lopez Pereira P, Espinosa L, Martinez Urrutina MJ, Lobato R, Navarro M, Jaureguizar E (2003) Posterior urethral valves: prognostic factors. BJU Int 91:687–690

    PubMed  Google Scholar 

  27. Greenfield SP, Hensle TW, Berdon WE, Wigger HJ (1983) Unilateral vesicoureteral reflux and unilateral non-functioning kidney associated with posterior urethral valves—a syndrome? J Urol 130:733–738

    CAS  PubMed  Google Scholar 

  28. Cuckow PM, Dinneen MD, Risdon RA, Ransley PG, Duffy PG (1997) Long-term renal function in the posterior urethral valves, unilateral reflux and renal dysplasia syndrome. J Urol 158:1004–1007

    CAS  PubMed  Google Scholar 

  29. Patil KK, Wilcox DT, Samuel M, Duffy PG, Ransley PG (2003) Management of urinary extravasation in 18 boys with posterior urethral valves. J Urol 169:1508–1511

    CAS  PubMed  Google Scholar 

  30. Beck AD (1971) The effect of intra-uterine urinary obstruction upon the development of the fetal kidney. J Urol 105:784–789

    CAS  PubMed  Google Scholar 

  31. Glick PL, Harrison MRL, Noall RA, Villa RL (1983) Correction of congenital hydronephrosis in utero. III. Early mid-trimester ureteral obstruction produces renal dysplasia. J Urol 18:681–687

    CAS  Google Scholar 

  32. Milliken LD Jr, Hodgson NB (1972) Renal dysplasia and urethral valves. J Urol 108:960–962

    PubMed  Google Scholar 

Download references

Acknowledgements

This study was financially supported by the Medical Research Fund of Tampere University Hospital and by a research grant from Helsinki University Central Hospital.

Author information

Authors and Affiliations

  1. Hospital for Children and Adolescents, University of Helsinki, PO Box 281, 00029 HUS, Helsinki, Finland

    Elisa Ylinen & Sakari Wikström

  2. Department of Pediatrics, Tampere University Hospital, Tampere, Finland

    Marja Ala-Houhala

Authors
  1. Elisa Ylinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marja Ala-Houhala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sakari Wikström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisa Ylinen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ylinen, E., Ala-Houhala, M. & Wikström, S. Prognostic factors of posterior urethral valves and the role of antenatal detection. Pediatr Nephrol 19, 874–879 (2004). https://doi.org/10.1007/s00467-004-1474-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-004-1474-4

Keywords

Search

Navigation