Evaluation of prenatal diagnosis of posterior urethral valve via ultrasound and its relationship with long term prognosis of patients

Abstract

Introduction and Objectives: Posterior Urethral Valve (PUV) is the most common obstructive uropathy in male infants, which is now commonly diagnosed in routine prenatal ultrasonography. The aim of this study was to evaluate the prognostic factors in fetal and postnatal period affecting long-term renal function. Methods: Retrospective review of all patients referred to our tertiary pediatric hospital between the years of 2001 to 2014 with provisional diagnosis of PUV, based on hydronephrosis seen on prenatal ultrasound scans. Results: During the years 2001 to 2014, 1500 patients with prenatal diagnosis of hydronephrosis were referred to our centre. On the other hand, 431 patients with provisional diagnosis of PUV were referred, of whom 116 were diagnosed during prenatal period. 37 patients were excluded from this study due to lack of appropriate follow up. 79 patients with provisional antenatal diagnosis of PUV based on US were included in our study. Several prognostic factors, including prenatal and postnatal sonographic parameters were evaluated along with renal function, and long term renal outcome. Gestational age at the time of diagnosis, amniotic fluid level, and presence of dilated ureter were considered on the prenatal ultrasound. At the end of our follow up, chronic renal failure was observed in 16.1% of our patients. Presence of a dilated ureter was the only sonographic parameter with a significant relationship with end stage renal disease (ESRD) (p < 0.05). Gestational age at diagnosis and oligohydramnios were unreliable predictors. Initial and nadir serum Creatinine were found to have a significant impact on the final renal outcome (p < 0.001). Conclusions: Based on our findings, detection of dilated ureter on prenatal ultrasound, can predict the incidence of ESRD in children with PUV. Initial and Nadir Serum creatinine are also significant prognostic factors. On the other hand, the result of our study suggests the improvement in outcome of children with PUV, who have undergone primary valve ablation together with bladder neck incision early during first years of their lives. However, a larger sample size and longer follow up period until adolescence is needed to prove this hypothesis.L6213521232018-03-27 <br />