Summary
Introduction
Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood.
Bladder and posterior urethral deformity in infants with PUV are highly variable on
initial voiding cystourethrogram (VCUG). Some types of deformity may be more important
than others in determining the severity of the condition. Identification of specific
VCUG features may allow for a simple, early screening assessment for patients.
Objective
Determine whether morphologic features on the initial VCUG correlate to renal outcomes
as measured by the creatinine nadir in the first year after ablation.
Methods
Children with PUV treated by primary valve ablation before 12 months old and followed
>1 year were identified. Initial diagnostic VCUG was evaluated for the bladder height
to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), and posterior-anterior
urethral ratio (PA-UR). A trabeculation grade was assigned by three pediatric urologists,
and reflux was noted. Univariable analyses with chi-square and t-test were used to
compare bladder and posterior urethral morphology factors among those who obtained
a creatinine nadir <0.8 or ≥0.8 mg/dL in the first year after ablation. Linear regression
was performed to correlate morphology values with true creatinine nadir.
Results
A total of 120 boys were ablated at mean age of 40.5 days (range 0–342) and followed
for 5.9 years (± 3.85). Among these, 21 (17.5%) had a creatinine nadir ≥0.8 mg/dL.
Mean overall HW-B and mean PA-UR were not significantly different between those with
creatinine nadir <0.8 versus ≥0.8 mg/dL. Bladder trabeculation grade was not associated
with creatinine nadir. For the entire cohort, only the difference in HW-PU was statistically
significant between creatinine nadir groups with a much higher ratio among those with
a nadir ≥0.8 (p < 0.001). Linear regression demonstrated a significant positive correlation
between the HW-PU and creatinine nadir (R 2 = 0.097, p = 0.002). The presence of bilateral
reflux is significantly associated with creatinine nadir ≥0.8 mg/dL (p = 0.001).
Discussion
We investigate for the first time the association of morphology features on the initial
VCUG with renal outcome in PUV patients. Posterior urethral deformity as quantified
by a higher HW-PU ratio is significantly correlated with a higher creatinine nadir,
whereas measured bladder morphology metrics are not. HW-PU may be an indirect measure
of the severity of obstruction in posterior urethral valves.
Conclusion
The HW-PU appears to be a meaningful early morphologic metric for renal outcome.
Keywords
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Article info
Publication history
Published online: June 15, 2022
Accepted:
June 2,
2022
Received in revised form:
May 30,
2022
Received:
January 6,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial comment on “Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves”Journal of Pediatric UrologyVol. 18Issue 6
- PreviewIn this interesting paper, the authors have studied the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), posterior-anterior urethral ratio (PA-UR) and bladder trabeculation grade on initial voiding cystourethrogram (VCUG) of children with posterior urethral valve (PUV) and found that only HW-PU significantly correlated with a higher nadir creatinine at one-year of age [1]. Niyogi [2] proposed that in children with PUV increasingly distorted bladder shape was associated with poor bladder dynamics and proposed shape, wall, reflux and diverticuli (SWRD) score.
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