Summary
Introduction
PUV patients managed with primary vesicostomy instead of primary valve ablation (PVA)
historically are preterm, low-birth-weight (LBW) infants with inadequate urethral
size. We previously described progressive urethral dilation (PUD) as an effective
method of enhancing the likelihood of PVA in these infants, allowing equal access
to PVA as an initial management method.
Objective
We aim to characterize renal outcomes in patients managed with PUD + PVA and compare
this to outcomes with PVA alone. We also re-examine the effect of LBW and gestational
age on renal outcomes in PUV with a cohort treated uniformly by PVA.
Methods
We performed retrospective review of 78 neonates with PUV treated with PVA prior to
10 weeks of age with >1 year of follow up. Before valve ablation, boys either underwent
PUD (serial upsizing of a smaller bore urethral catheter to an 8Fr catheter; PUD + PVA)
or non-dilation (smaller bore catheter was maintained; PVA-only). PUD + PVA versus
PVA-only was compared using chi-square and t-test. Logistic regression was performed
to assess the effect of PUD, preterm (<37 weeks), LBW (<2.5 kg), and other predictors
on the final outcomes of CKD3+ and ESRD.
Results
31 of 78 patients underwent PUD + PVA. Mean follow up was 5.2 years (SD 3.4), with
no significant difference between PUD + PVA and PVA-only. The PUD + PVA group included
significantly lower gestational age infants with lower birth weight and ablation weight.
There was no significant effect of PUD on final CKD3+ or ESRD outcome on univariable
or multivariable analysis. When adjusted for other variables, only Cr nadir >0.5 remained
an independent predictor of CKD3+ (OR 41.2; p < 0.001) and ESRD (OR 18.9; p = 0.015).
Discussion
We previously demonstrated that PUD is an effective means to achieve PVA in small
neonates who might otherwise require vesicostomy. The data herein demonstrates no
significant effect of PUD on renal outcomes. In this unique cohort of newborns treated
with PVA, only creatinine nadir and not gestational age or an independent predictor
of outcomes.
Conclusion
Summary Table
| Univariable | Multivariable | |||
|---|---|---|---|---|
| CKD3+ | OR (95% CI) | p | OR (95% CI) | p |
| Prenatal diagnosis | 1.909 (0.686–5.310) | 0.215 | ||
| Preterm | 4.222 (1.499–11.892) | 0.006 | 1.955 (0.261–14.653) | 0.514 |
| Low birth weight | 5.000 (1.343–18.620) | 0.016 | 2.900 (0.318–26.458) | 0.345 |
| VUR present | 3.237 (1.161–9.029) | 0.025 | 3.764 (0.590–24.026) | 0.161 |
| VUR bilateral | 3.321 (1.094–10.082) | 0.034 | ∗ | |
| VUR high grade | 2.564 (0.939–7.003) | 0.066 | ∗ | |
| PUD | 1.548 (0.575–4.164) | 0.387 | 0.518 (0.083–3.242) | 0.482 |
| Catheter duration | 1.044 (0.989–1.103) | 0.117 | ||
| Cr Nadir >0.5 | 35.700 (8.604–148.120) | <0.001 | 41.196 (6.701–253.258) | <0.001 |
| ESRD | OR (95% CI) | p | OR (95% CI) | p |
| Prenatal diagnosis | 1.344 (0.390–4.629) | 0.640 | ||
| Preterm | 2.231 (0.601–8.282) | 0.231 | ||
| Low birth weight | 4.167 (1.042–16.660) | 0.044 | 1.328 (0.124–14.207) | 0.814 |
| VUR present | 4.321 (1.082–17.252) | 0.038 | 9.848 (0.865–112.095) | 0.065 |
| VUR bilateral | 2.686 (0.781–9.241) | 0.117 | ∗ | |
| VUR high grade | 3.815 (1.055–13.799) | 0.041 | ||
| PUD | 1.016 (0.298–3.466) | 0.980 | 0.425 (0.050–3.596 | 0.432 |
| Catheter duration | 1.093 (1.023–1.168) | 0.009 | 1.086 (0.947–1.246) | 0.328 |
| Cr Nadir >0.5 | 28.750 (3.407–242.627) | 0.002 | 18.903 (1.772–201.628) | 0.015 |
∗Supplemental Table
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Current epidemiology and antenatal presentation of posterior urethral valves: outcome of BAPS CASS National Audit.J Pediatr Surg. 2019; 54: 318-321
- Current strategies to predict and manage sequelae of posterior urethral valves in children.Pediatr Nephrol. 2018; 33: 1651-1661
- Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation.J Urol. 2008; 179 (; discussion 12-3): 307-312
- Early valve ablation can decrease the incidence of bladder dysfunction in boys with posterior urethral valves.J Urol. 2009; 182: 1765-1768
- Bladder function associated with posterior urethral valves after primary valve ablation or proximal urinary diversion in children and adolescents.J Urol. 2002; 168 (; discussion 5): 1830-1835
- Lower urinary tract changes after early valve ablation in neonates and infants: is early diversion warranted?.J Urol. 1997; 157: 984-988
- The long-term outcome of posterior urethral valves treated with primary valve ablation and observation.J Urol. 1996; 155: 1730-1734
- Role of a preoperative catheter regimen in achieving early primary endoscopic valve ablation in neonates with posterior urethral valves.J Urol. 2021; 205: 1792-1797
- New equations to estimate GFR in children with CKD.J Am Soc Nephrol. 2009; 20: 629-637
- (progressive augmentation by dilating the urethra anterior) procedure for the treatment of severe urethral hypoplasia.J Urol. 1988; 140: 1247-1249
- Posterior urethral valves: impact of low birth weight and preterm delivery on the final renal outcome.Arab J Urol. 2017; 15: 159-165
- Assessment of kidney function in preterm infants: lifelong implications.Pediatr Nephrol. 2016; 31: 2213-2222
- Short-term gestation, long-term risk: prematurity and chronic kidney disease.Pediatrics. 2013; 131: 1168-1179
- Renal outcomes of neonates with early presentation of posterior urethral valves: a 10-year single center experience.J Perinatol. 2020; 40: 112-117
- Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome.J Urol. 2011; 185: 2491-2495
- Posterior urethral valves: risk factors for progression to renal failure.J Pediatr Urol. 2016; 12: 179 e1-7
- Risk factors for progression to end-stage renal disease in children with posterior urethral valves.J Pediatr Urol. 2010; 6: 261-264
- Long-term risk of end stage renal disease in patients with posterior urethral valves.J Urol. 2011; 186: 2392-2396
- Nadir creatinine in posterior urethral valves: how high is low enough?.J Pediatr Urol. 2015; 11: 356 e1-5
- Risk factors for end stage renal disease in children with posterior urethral valves.J Urol. 2008; 180 (; discussion 8): 1705-1708
- Predicting childhood chronic kidney disease severity in infants with posterior urethral valve: a critical analysis of creatinine values in the first year of life.Pediatr Nephrol. 2022; 37: 1339-1345
Article info
Publication history
Published online: June 15, 2022
Accepted:
June 1,
2022
Received in revised form:
May 9,
2022
Received:
February 7,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
