Posterior urethral valves: long-term outcome

Pediatr Surg Int. 2011 Oct;27(10):1027-35. doi: 10.1007/s00383-011-2946-9. Epub 2011 Jul 12.

Abstract

Posterior urethral valves represent the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. Long-term outcome of patients with previous PUV is evaluated. Patients over 18 years of age, treated from 1982 to 1995 before the age of 3 years were considered. Previous surgery, renal function, bladder activity, urinary incontinence, and fertility/sexual activity were evaluated. Clinical interview, creatinine clearance, uroflowmetry with ultrasound post-void urine residue, and self-administered questionnaire were recorded. Out of 45 identified records, 24 patients (53.3%) accepted to be enrolled (age 18-34 years, mean 23 years). The mean follow-up was 19.5 years (16-30 years). Out of the 21 excluded patients, 20 did not reply to the clinical interview and 1 died at age of 6 years. All the 24 patients had early endoscopic section of PUV; nine also received transient ureterocutaneostomy or vesicostomy. Ureteroneocystostomy was performed in five patients and ureterocystoplasty with unilateral nephrectomy in two. At follow-up chronic renal failure was detected in 13 patients (54.1%) and 9 (37.5%) had arterial hypertension. End-stage renal disease developed in five patients (20.8%): three had successful renal transplantation and two were in dialysis. Lower urinary tract symptoms were present in seven patients (29.1%). No significant fertility deficit and sexual dysfunction were observed in 23 patients, while 1 patient was azoospermic. No paternity was reported so far. Long-term outcome of patients with previously treated PUV is mandatory. Kidney, bladder, and sexual functions should be monitored till adulthood to verify any modified behaviour.

MeSH terms

  • Adolescent
  • Adult
  • Child, Preschool
  • Continuity of Patient Care
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infertility, Male / etiology
  • Italy
  • Kidney Failure, Chronic / etiology
  • Male
  • Pregnancy
  • Prenatal Diagnosis
  • Retrospective Studies
  • Sexual Dysfunction, Physiological / etiology
  • Survival Analysis
  • Treatment Outcome
  • Urethral Stricture / complications
  • Urethral Stricture / congenital
  • Urethral Stricture / diagnosis
  • Urethral Stricture / surgery*
  • Urinary Bladder Neck Obstruction / complications
  • Urinary Bladder Neck Obstruction / congenital
  • Urinary Bladder Neck Obstruction / diagnosis
  • Urinary Bladder Neck Obstruction / surgery*
  • Urologic Diseases / etiology*
  • Urologic Diseases / prevention & control